A Novel Use of a Novel Drug: Preoperative Nasal Preparation with Dexmedetomidine for Transnasal Transsphenoidal Neurosurgery Approach in Skull Base Neurosurgery
22 March 2017
25 May 2017
13 October 2017 (eFirst)
Introduction Transnasal transsphenoidal (TNTS) approach is preferred for surgical excision of the pituitary gland. Despite its numerous merits, the TNTS approach creates wide fluctuations in hemodynamic parameters that are attributed to the routine application of adrenaline-soaked nasal packing and the intense noxious stimulus during the surgery.
Aims To evaluate the effect of dexmedetomidine for preoperative nasal passage preparation on the surgical field visualization and hemodynamic profile of patients during TNTS surgery.
Material and Methods Cotton strips soaked in dexmedetomidine were used for nasal preparation. The primary outcomes studied were the quality of surgical field visualization through the endoscope and the amount of bleeding that occurred while raising the nasal mucosal flap. The secondary outcomes assessed were the intraoperative anesthetic and analgesic requirement and the hemodynamic profile.
Statistical Analysis Data from the study were summarized as mean and SD. Associations were tested using chi-square test for nonparametric data and for continuous variables ANOVA for repeated measures. A p-value < 0.05 was considered as statistically significant and < 0.01 as highly significant. SPSS 17.0 was used for analysis.
Results Seventeen (85%) patients had a Formmer's score of 1, which was an excellent surgical field quality. Two (10%) patients had a Formmer's score of 2, and one (5%) had a Formmer's score of 3. There were no statistically significant variations in heart rate and blood pressure with reduced anesthetic requirement.
Conclusion Intranasal dexmedetomidine provides good surgical field conditions with the added advantage of lesser hemodynamic fluctuations.
- 1 Jane Jr JA, Thapar K, Kaptain GJ, Maartens N, Laws Jr ER. Pituitary surgery: transsphenoidal approach. Neurosurgery 2002; 51 (02) 435-442 , discussion 442–444
- 2 Kuroki A, Kayama T. Endoscopic approach to the pituitary lesions: contemporary method and review of the literature. Biomed Pharmacother 2002; 56 (Suppl. 01) 158s-164s
- 3 Pasternak JJ, Atkinson JL, Kasperbauer JL, Lanier WL. Hemodynamic responses to epinephrine-containing local anesthetic injection and to emergence from general anesthesia in transsphenoidal hypophysectomy patients. J Neurosurg Anesthesiol 2004; 16 (03) 189-195
- 4 Cafiero T, Cavallo LM, Frangiosa A. , et al. Clinical comparison of remifentanil-sevoflurane vs. remifentanil-propofol for endoscopic endonasal transphenoidal surgery. Eur J Anaesthesiol 2007; 24 (05) 441-446
- 5 Nemergut EC, Dumont AS, Barry UT, Laws ER. Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg 2005; 101 (04) 1170-1181
- 6 Smith M, Hirsch NP. Pituitary disease and anaesthesia. Br J Anaesth 2000; 85 (01) 3-14
- 7 Cohen-Kerem R, Brown S, Villaseñor LV, Witterick I. Epinephrine/Lidocaine injection vs. saline during endoscopic sinus surgery. Laryngoscope 2008; 118 (07) 1275-1281
- 8 Hsu YW, Cortinez LI, Robertson KM. , et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 2004; 101 (05) 1066-1076
- 9 Cortinez LI, Hsu YW, Sum-Ping ST. , et al. Dexmedetomidine pharmacodynamics: Part II: crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 2004; 101 (05) 1077-1083
- 10 Ramsay MAE, Luterman DL. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology 2004; 101 (03) 787-790
- 11 Angst MS, Ramaswamy B, Davies MF, Maze M. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans. Anesthesiology 2004; 101 (03) 744-752
- 12 Cheung CW, Qiu Q, Liu J, Chu KM, Irwin MG. Intranasal dexmedetomidine in combination with patient-controlled sedation during upper gastrointestinal endoscopy: a randomised trial. Acta Anaesthesiol Scand 2015; 59 (02) 215-223
- 13 Qiao H, Chen J, Li W, Shen X. Intranasal atomised dexmedetomidine optimises surgical field visualisation with decreased blood loss during endoscopic sinus surgery: a randomized study. Rhinology 2016; 54 (01) 38-44
- 14 Cheung CW, Ng KFJ, Liu J, Yuen MY, Ho MHA, Irwin MG. Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia. Br J Anaesth 2011; 107 (03) 430-437
- 15 Talke P, Lobo E, Brown R. Systemically administered alpha2-agonist-induced peripheral vasoconstriction in humans. Anesthesiology 2003; 99 (01) 65-70
- 16 Talke P, Richardson CA, Scheinin M, Fisher DM. Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine. Anesth Analg 1997; 85 (05) 1136-1142
- 17 Yabuki A, Higuchi H, Yoshitomi T. , et al. Locally injected dexmedetomidine induces vasoconstriction via peripheral α-2A adrenoceptor subtype in guinea pigs. Reg Anesth Pain Med 2014; 39 (02) 133-136
- 18 Kim HJ, Sohn JT, Jeong YS. , et al. Direct effect of dexmedetomidine on rat isolated aorta involves endothelial nitric oxide synthesis and activation of the lipoxygenase pathway. Clin Exp Pharmacol Physiol 2009; 36 (04) 406-412
- 19 Tang C, Huang X, Kang F. , et al. Intranasal dexmedetomidine on stress hormones, inflammatory markers, and postoperative analgesia after functional endoscopic sinus surgery. Mediators Inflamm 2015; 2015: 939431
- 20 Miller JW, Divanovic AA, Hossain MM, Mahmoud MA, Loepke AW. Dosing and efficacy of intranasal dexmedetomidine sedation for pediatric transthoracic echocardiography: a retrospective study. Can J Anaesth 2016; 63 (07) 834-841
- 21 Ambi US, Joshi C, Ganeshnavar A, Adarsh E. Intranasal dexmedetomidine for paediatric sedation for diagnostic magnetic resonance imaging studies. Indian J Anaesth 2012; 56 (06) 587-588
- 22 John G, Low JM, Tan PE, van Hasselt CA. Plasma catecholamine levels during functional endoscopic sinus surgery. Clin Otolaryngol Allied Sci 1995; 20 (03) 213-215
- 23 Iirola T, Vilo S, Manner T. , et al. Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol 2011; 67 (08) 825-831
- 24 Gopalakrishna KN, Dash PK, Chatterjee N, Easwer HV, Ganesamoorthi A. Dexmedetomidine as an anesthetic adjuvant in patients undergoing transsphenoidal resection of pituitary tumor. J Neurosurg Anesthesiol 2015; 27 (03) 209-215
- 25 Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: a wonder drug?. Indian J Anaesth 2011; 55 (04) 323-324