Comparison of controlled sedoanalgesia and general anesthesia in dacryocystorhinostomy surgery

In our study, we aim to compare general anesthesia and controlled sedoanalgesia methods in dacryocystorhinostomy (DCR) surgery in terms of hemodynamic data, bleeding amount, postoperative complications (bleeding, pain, etc.) and anesthesia satisfaction in a prospective and randomized controlled manner. The study is carried out in 44 patients over the age of 18 with ASA classification I-II-III, who will undergo primary external DCR, after ethics committee approval and written informed consent from the patients. The patients are randomly divided into 2 groups to general anesthesia (GA, n=22) and controlled sedoanalgesia (SA, n=22). Standard general anesthesia is performed to the GA group and dexmedetomidine (1 µq/kg loading for 10 minutes, 0.6 µq/kg infusion), midazolam (0.04 mg/kg) and meperidine (50 mg intramuscular) are administered to the SA group. Depth of anesthesia is monitored with a bispectral index (BIS) in both groups. Peroperative hemodynamic data and BIS values (preoperative, 5 minutes after surgical incision, 10th, 20th, 30th and 40th minutes intraoperatively), amount of bleeding, duration of surgery and duration of anesthesia are recorded. Percentage changes of heart rate and peripheral oxygen saturation in the intraoperative period in both groups were similar to preoperative values at all measurement times (p>0.05 for all). According to the preoperative value, the mean blood pressure decrease was found to be higher at all measurement times in the GA group (p=0.010, p=0.006, p=0.031, p=0.037, p=0.001). Intraoperative bleeding amount, duration of surgery and duration of anesthesia, postoperative pain scores and complications were similar in both groups (p>0.05 for all). Patient satisfaction was significantly higher in the SA group (p=0.033). Based on these findings, we have a strong belief that sedoanalgesia with BIS monitoring can be an alternative to general anesthesia in selected cases of external DCR surgery since the hemodynamic parameters, intraoperative bleeding, and complications are similar to GA and patient satisfaction is higher. Keywords: Dacryocystorhinostomy, sedoanalgesia, dexmedetomidine, bispectral index, general anesthesia