SEVOFLURANE VERSUS PROPOFOL POUR L’HYPOTENSION CONTROLEE EN CHIRURGIE ORL
SEVOFLURANE VERSUS PROPOFOL POUR L’HYPOTENSION CONTROLEE EN CHIRURGIE ORL
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Date
2021-06-03
Authors
Docteur MEFTAH Hayet
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Abstract
Introduction:
Rhinosinus endoscopic surgery and microsurgery of the ear poses the problem of bleeding putting in difficulty the
surgeons in the realization of their act. This situation led us to develop an anesthetic protocol inducing a controlled
hypotension allowing a quality surgery.
The objective of this study is to compare the action of two anesthetic products, sevoflurane by inhalation and propofol
by continuous infusion, in controlled hypotension in patients operated on for middle ear or nasal cavity surgery
Methods:
This is a randomized therapeutic trial over a period spanning from February 2016 to January 2018, having included
110 patients who were candidates for endonasal or middle ear surgery at the ENT department of the CHU of Tlemcen.
Our sample was split into two groups, those who received the sevoflurane protocol (n=56) and those who received the
propofol protocol (n=54)
A comparison between the two protocols, on the basis of the different parameters studied, in particular, the delay in
obtaining hypotension, intraoperative hemodynamic variations, recourse or not to hypotensive drugs, satisfaction of
the surgical team due to a better exsanguinite of the operating field, as well as the operative duration and postoperative
complications
Results
The average age of the patients in our sample was 37.63 ± 14.73 years with a sex ratio of 1.7 in favor of women.
58.4% of the patients were candidates for otological surgery compared with 38.9% for nasal surgery.
In the sevoflurane protocol, the mean time to hypotension was 11.15 ± 7.66 min (p= 0.029), with good control of MAP
until T 85 (p moy = 0.011). Surgical field exsanguinity was achieved in 87.5% (p= 0.041), only 28.6% of patients
required antihypertensive medication (p = 0.001), surgeon satisfaction was achieved in 89.28% (p= 0.005) and
recovery time was shorter (p = 0.003).
No complication of controlled hypotension was reported in both protocols.
Conclusion
The results of our study allowed us to evaluate the action of two products on anesthetic maintenance and also on the
surgical field.
The conclusions based on the improvement of the operative conditions according to the modified Fromm's grading
scale, the time to obtain the target MAP and its control, as well as the surgeon's satisfaction and the recovery time,
were good for both drugs with a significantly higher improvement for the sevoflurane protocol.