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Docteur MEFTAH Hayet
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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.