engleski

The influence of different anesthetic techniques on intraoperative bleeding during endoresection of choroidal melanoma.

Endoresection of choroidal melanoma has a high risk of intraoperative bleeding which has to be reduced because it impairs surgical conditions and increases the risk of expulsive hemorrhage. This study presents the influence of different anaesthetic techniques on bleeding during this procedure. Nine consecutive patients under general hypothensive anaesthesia (mean arterial pressure of 50-65 mmHg, MAP) were reviewed retrospectively. Anaesthetic techniques were based on the comorbidities of patients. In six patients hypothensive anesthesia was based only on a combination of volatile anaesthetics isoflurane or sevoflurane with opioids fentanyl or sufentanil. Three patients in addition received nitroglycerin (NTG) (n=1 ; 1 µg kg-1 min-1), urapidil (n=1 ; intravenous bolus of 12.5 mg) or esmolol (n=1 ; intravenous bolus of 1 mg/kg). The operative field was evaluated using the Surgeon’s Scale for Quality of Surgical Field (bleeding score). MAP, HR and bleeding score were analysed. Hypotension was achieved at the target MAP in four patients (two with only volatile anaesthetic and opioid ; two NTG or esmolol). HR was reduced to ≤60 beat/min in four patients (three with only volatile anaesthetic and opioid ; one with esmolol). The patient with esmolol had the best bleeding score of 1. The used technique of moderate hypotension and bradycardia with intraoperative β blockade is the most effective in reduction of intraoperative bleeding associated with choroidal melanoma resection.

Choroidal melanoma; intraoperative bleeding; anaesthetic techniques

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