Relatively light general anesthesia is more effective than fluid expansion in reducing the severity of epinephrine-induced hypotension during functional endoscopic sinus surgery

摘要

＜正＞ Background Epinephrine infiltration of the nasal mucosa causes hypotension during functional endoscopic sinussurgery（FESS）under general anesthesia.A prospective randomized-controlled study was designed to determinewhether relatively light general anesthesia is superior to fluid expansion in reducing epinephrine-induced hypotensionduring FESS.Methods Ninety patients undergoing elective FESS under general anesthesia were randomly assigned to threegroups with 30 patients in each.Each patient received local infiltration with adrenaline-containing（5 μg/ml）lidocaine（1%,4 ml）under different conditions.For Group Ⅰ,anesthesia was maintained with propofol 2 μg/ml and rimifentanil 2 ng/ml byTCI.Group Ⅱ（control group）and Group Ⅲ received propofol 4 μg/ml and rimifentanil 4 ng/ml,respectively.In Groups Ⅰand Ⅱ,fluid expansion was performed with hetastarch 5 ml/kg within 20 minutes;hetastarch 10 ml/kg was used in GroupⅢ.Mean arterial pressure（MAP）and heart rate（HR）were recorded at 30-second-intervals for 5 minutes after thebeginning of local infiltration.Simultaneously,the lowest and the highest MAP were recorded to calculate the meanmaximum increase or decrease percent in MAP for all patients in each group.Data analysis was performed by χ~2 test,one-way analysis of variance,or one-way analysis of covariance.Results Hemodynamic changes,particularly a decrease in MAP accompanied by an increase in HR at 1.5 minutes（P＜0.05）,were observed in all groups.The mean maximum decrease in MAP below baseline was 14% in Group Ⅰ,24% inGroup Ⅲ and 26% in Group Ⅱ.There were statistically significant differences between Group Ⅰ and Groups Ⅱ and Ⅲ（P＜0.05）.The mean maximum increase in MAP above baseline was 9% in Group Ⅰ,6% in Group Ⅲ and 2% in Group Ⅱ.Conclusion Relatively light general anesthesia can reduce the severity of epinephrine-induced hypotension moreeffectively than fluid expansion during FESS under general anesthesia.Chin Med J 2007;120（15）:1299-1302