R. Chadha et al., PREVENTION OF HYPERTENSION DURING TRANS-SPHENOIDAL SURGERY - THE EFFECT OF BILATERAL MAXILLARY NERVE BLOCK WITH LOCAL-ANESTHETICS, Acta anaesthesiologica Scandinavica, 41(1), 1997, pp. 35-40
Background: Severe cardiovascular responses are known to occur during
trans-sphenoidal excision of the pituitary gland despite adequate dept
h of anaesthesia. This study was undertaken to evaluate the effects of
bilateral maxillary nerve block with local anaesthetics on the cardio
vascular responses to various stimuli during this procedure. Methods:
In a group of 32 patients, 5-10 mi of a mixture of bupivacaine 0.5% an
d lignocaine 2% (1:1) was injected in the pterygopalatine fossa after
induction of general anaesthesia. Seven control group patients did not
receive any nerve block. In all the patients, general anaesthesia was
induced with thiopentone and maintained with nitrous oxide-oxygen, pe
ntazocine, boluses of thiopentone and halothane. Pancuronium was used
for neuromuscular blockade. Results: In both the groups, maximum hyper
tension occurred on opening the blades of the bivalve nasal speculum.
In the study group, hypertensive response was significantly less follo
wing nasal infiltration with adrenaline containing solution (10.26% in
crease vs. 23.08% in the control group, P<0.05), nasal dissection (2.8
2% vs. 9.45%, P<0.01) and on application of the nasal speculum (14.93%
vs. 35.16%, P<0.01). The effect on heart rate response was not signif
icant.Conclusion: The described technique is a useful adjunct to gener
al anaesthesia for suppressing the haemodynamic responses during trans
-sphenoidal surgery.