| Objective: to study the efficacy,feasibility and safety of fentanyl in non-controlled hypotensive anesthesia in nasal endoscopic surgery,and to explore the appropriate dose of fentanyl in this application.Methods: forty-five patients(ASA grade?or?degree,age 18~45years,after 3~7days standardized treatment to control inflammation)undergoing endoscopic sinus surgery were randomly assigned into thr ee groups:group I,group II and group III.Fentanyl was give 3?g/k g during induction of anesthesia,before the start of the operation,th e group?was supplemented with fentanyl 1.5?g/kg,group II was add ed fentanyl 2.5?g/kg,group ?was added fentanyl 3.5?g/kg.Anaesthesi a induction drugs also include midazolam,cis-type atracurium,propof ol,the anesthesia was maintained by inhaltion of sevoflurane during t he operation.Monitor hemodynamics continuously.Systolic blood press ure(SP),diastolic blood pressure(DP),mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),stroke volume(SV),SSFQ score and extubation time and postoperative complications were observed a nd recorded before induction(T1),at the beginning of operation(T2),at 15 min(T3),30 min(T4)after surgery,when the PVA is packed(T5).Results:(1)Homodynamic: The MAP,HR and CO of group I at T2 and T3 were all lower than those at T1.There is a statistical significance(P<0.05).There was no significant difference at T4 and T1(P>0.05).The MAP,HR and CO of group I and group II at T2,T3 and T4 were all lower than those at T1.There is a statistical significance(P<0.05).There was no difference among the three groups' MAP,HR and CO when the operationbegan to 30 min and the medical PVA cotton was stuffed.After the addition of fentanyl,there was no significant change in SV at all time points,and there was no significant difference(P>0.05).Compared with group I,the MAP,HR and CO of group II and group III at T3 and T4 were lower than those in group I.There is a statistical significance(P<0.05).In group II and group III,there was no significant difference in MAP,HR and CO at T3 and T4(P>0.05).(2)(SSFQ)Score of surgical field quality:Compared with group I(2.50±0.53),the quality of operative field in group II(1.75±0.46)and group III(1.62±0.51)was higher than that in group I(P<0.05),and there was no significant difference between group II and group III(P>0.05).(3)Extubation time:Group I(16.40±1.14)min had no significant difference from group II(17.60±2.07)min(P>0.05);group III(24.60±2.30)min had longer extubation time than group II(P<0.05).(4)Adverse effects of intraoperative and postoperative:In group I,three cases of choking reaction occurred during extubation,and the incidence of adverse reactions was15%.In group III,one case of hypotension and two cases of low heart rate were found.The appropriate dose of ephedrine and atropine were used.The incidence of adverse reactions was 15%.There was one case of postoperative nausea in group II,and the incidence of adverse reactions was 5%.No respiratory depression occurred after the postoperative follow-up.The incidence of adverse reaction in group II was significantly lower than that in group I and group III.Conclusion: fentanyl 3?g/kg is recommended for anesthesia induc tion,and fentanyl 2.5?g/kg before operation can be used for non ope rative controlled hypotension during endoscopic sinus surgery.This m ethod is effective,safe and feasible. |
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