Effect of bleeding on the surgical field in dexmedetomidine infusion patients undergoing endoscopic sinus surgery under general anesthesia

Background: In order to secure an ideal surgical field for endoscopic sinus surgery (ESS), it is necessary to reduce intraoperative bleeding. Intraoperative intra-nasal bleeding is influenced by various anesthetics. The present study focuses on the differences between sevoflurane/ remifentanil (SR)-based anesthesia and sevoflurane/remifentanil/dexmedetomidine (SRD)- based anesthesia in terms of surgical field conditions. Methods: American Society of Anesthesiologists physical status class I or II patients undergoing ESS were randomly assigned to the SR (n=36) or SRD (n=32) group. In order to assess the visibility of the surgical field, the level of intraoperative bleeding was rated on a 6-point numeric rating scale (NRS). Computed tomography findings were used to evaluate the extent of each preoperative surgical lesion, as high (＞12) vs. low (≤12) Lund-Mackay (LM) score. A single surgeon was in charge of rating the visibility of the surgical field on an NRS every 5 minutes, and the worst NRS was used as a representative value for each group. Results: The NRS of the surgical field was not significantly different between the two groups (p=0.089). However, in the high-LM score patients, the NRS of the surgical field was significantly better in the SRD group than in the SR group (p=0.009). Conclusions: In the high- LM score patients, SRD-based anesthesia resulted in better surgical field conditions for ESS than did SR-based anesthesia. Therefore, we conclude that SRD-based anesthesia is beneficial in ESS.