Objective: Two different concentrations of ketamine 0.5 mg/kg, 0.25 mg/kg were applied to both tonsils perioperatively to check analgesic effect postoperatively in children. This study done at Department of anesthesia and otorhinolaryngology, faculty of medicine, Al-Azhar University hospitals, and the medical ethics committee. The study was conducted in the ENT operating theatre, Al-Azhar University Hospitals, from Jan. 2017 to June 2018. Methodology: We divided patients into 3 groups K1, K2 and S each group 25 patients, group K1 had 0.25 mg ketamine, group k2 had 0.5 mg ketamine and group S had normal saline as a control group. These groups assessed intraoperatively by Heart rate and main arterial pressure (MAP) were recorded at the intervals together with Ventilation parameters. Postoperative pain assessment by using Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The sedative condition was assessed with the Wilson sedation scale at 5, 15, 30, and 60 min after entrance to the PACU. CHEOPES was recorded only when patient modified Wilson sedation score was one. Incidences of postoperative complications as: blood loss, dysphagia, nausea and vomiting were noted and demonstrated; hallucinations will be observed and recorded. Results: There were no significant differences among the groups regarding age, gender and weight. There were no significant differences among the groups with respect to the demographic data, duration of surgery or anesthesia, and intraoperative blood loss. As regarding hemodynamics, mean blood pressure was significantly lower in group (K1) than group S (control group) at 20 and 30 minutes after injection of ketamine and significantly lower in group (K2) than group S (control group) at 20 and 30 minutes after injection of ketamine with no difference between group (K1) and (K2).

Background: Functional endoscopic sinus surgery is widely practiced during daily otorhinolaryngology practice. It usually done under low blood pressure. However, the ideal hypotensive drug or technique is yet not well established. Aim of the work: To evaluate outcome of functional endoscopic sinus surgery under esmolol-induced hypotensive anesthesia [EHA] versus hypotensive total intravenous anesthesia [H-TIVA]. Patients & Methods: 72 patients were randomly divided into two groups; Group A: H-TIVA and Group B [EHA]. After induction of anesthesia, remifentanil/ propofol and esmolol infusions were adjusted to maintain mean arterial pressure at 60-70 mmHg. After completion of surgical procedure, esmolol infusion was stopped, while remifentanil/propofol infusions were adjusted to allow restoration of blood pressure. Operative field bleeding and visibility were graded using Fromme scale. Primary outcome is the efficacy of EHA to minimize intraoperative bleeding to an extent that allows satisfactory completion of surgery. Results: Esmolol bolus significantly attenuated pressor reflexes to induction and intubation than induction by remifentanil. Intraoperative [IO] heart rate and MAP measures were significantly lower with EHA. At 10-minures after infusion stoppage, patients of group B still had significantly lower HR and MAP, while at 10-min later, the difference was nonsignificant. HA minimized IO blood loss down to no to slight bleeding in 16.7% and 55.5% of studied patients and improved field visibility to satisfactory-to-good levels in 51.4% and 43.1% of surgeries, respectively. Moreover, EHA provided better field visibility, so allowed significant reduction of operative time than with TIVA. Conclusion: Hypotensive anesthesia is safe and appropriate modality for FESS and improves surgical and clinical outcome. Both esmolol and remifentanil provided satisfactory results. Esmolol is superior to remifentanil.