Asunto(s)
Anestesia/métodos , Neoplasias Cardíacas/complicaciones , Neoplasias Infratentoriales/complicaciones , Neoplasias Infratentoriales/cirugía , Androstanoles , Anestésicos Intravenosos , Anestésicos Locales , Fosa Craneal Posterior/cirugía , Femenino , Fentanilo , Humanos , Lidocaína , Persona de Mediana Edad , Fármacos Neuromusculares no Despolarizantes , Posición Prona , Propofol , RocuronioRESUMEN
Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I-II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 µg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (P<0.05). There was a rise in the mean arterial pressure during and 5, 10, and 15 minutes after nasal speculum insertion in the control group, whereas it was not seen in other groups (P<0.05). We therefore suggest that oral clonidine and oral atenolol (given 2 hours prior to surgery) is an equally effective and safe method of attenuating haemodynamic response caused by nasal speculum insertion during trans-sphenoid pituitary resection.