The Influence of Blood Pressure Upon the Clarity of Surgical Field in Endonasal Surgery

The work compares the effect of different various values of arterial blood pressure on the clarity of the surgical field in pansinusoperation in patients with chronic rhinosinusitis.

The work compares the effect of different values of arterial pressure on the clarity of the surgical field in pansinus operation in patients with chronic rhinosinusitis. A secondary goal of the study is to compare circulatory parameters, depth of anaesthesia, near-infrared spectroscopy (NIRS) and consumption of hypotensives. Null hypothesis: There is no difference in the clarity of the surgical field at various levels of the mean arterial pressure. This study is being realized in accordance with the Declaration of Helsinki and has been approved by the Ethics Committee of the University Hospital Ostrava (849/2018). According to the statement of the State Institute for Drug Control of 26th April 2019 (reference number Sukl96964/2019), the trial is not considered a clinical trial of medicinal products. Study type: Single-blind study (the surgeon does not know the value of the patient's blood pressure) prospective study.

The physician performing the surgery and assessing the surgical field clarity will be masked as to the value of the blood pressure in the individual patient.

Controlled hypotension will be administered according to the clarity of the surgical field evaluated according to the Boezaart scale (1995).

Clarity of the surgical field will be assessed on a scale of 0-5, according to the Boezaart's system (1995)

Blood pressure will be measured in the morning before surgery, on arrival at the operating theatre and further 5 minutes after anaesthesia, and every five minutes during the surgery.

Heart rate will be measured in the morning before surgery, on arrival at the operating theatre and further 5 minutes after anaesthesia, and every five minutes during the surgery.

Postoperative pain will be measured using the VAS (Visual Analogue Scale) upon arrival to the recovery room and the standard ward.

The presence of complications of controlled hypotension (stroke, myocardial infarction, kidney injury - YES/NO) will be observed.

Inclusion Criteria: Patients with chronic rhinosinusitis undergoing pansinusoperation Age over 18 years Concrete surgeon (Petr Matoušek, MD, Ph.D., MBA) Concrete anaesthetist (Michal Parma, MD) Exclusion Criteria: Coagulopathy Thrombocytopathies Vascular wall disorders Thrombophlebitis Anticoagulation or anti-aggregation therapy History of malignancy Pregnancy

Thongrong C, Kasemsiri P, Carrau RL, Bergese SD. Control of bleeding in endoscopic skull base surgery: current concepts to improve hemostasis. ISRN Surg. 2013 Jun 13;2013:191543. doi: 10.1155/2013/191543. Print 2013.

Kelly EA, Gollapudy S, Riess ML, Woehlck HJ, Loehrl TA, Poetker DM. Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia. Int Forum Allergy Rhinol. 2013 Jun;3(6):474-81. doi: 10.1002/alr.21125. Epub 2012 Dec 19.

Athanasiadis T, Beule A, Embate J, Steinmeier E, Field J, Wormald PJ. Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study. Laryngoscope. 2008 Feb;118(2):314-9. doi: 10.1097/MLG.0b013e318157f764.

Milonski J, Zielinska-Blizniewska H, Golusinski W, Urbaniak J, Sobanski R, Olszewski J. Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 2013 Jul;270(7):2045-50. doi: 10.1007/s00405-012-2311-1. Epub 2012 Dec 22.