A comparison of effects of oral premedication with clonidine and metoprolol on intraoperative hemodynamics and surgical conditions during functional endoscopic sinus surgery

Abstract

Context:Establishing a near perfect surgical field during functional endoscopic sinus surgery (FESS) is essential and even a minor bleeding can severely compromise an already restricted view. So, if controlled hypotension can be provided without compromising the safety of patient by a relatively effortless method, surgical field can be improved greatly.Aims:The aim of this study was to compare the hemodynamic changes and surgical conditions during FESS following oral premedication with clonidine and metoprolol.Settings and Design:A total of 40 patients undergoing FESS were included in this prospective, randomized controlled study.Subjects and Methods:Patients were divided into two equal groups. Group A patients were premedicated with oral clonidine 300 mcg and Group B with oral metoprolol 50 mg, 2 h before surgery. All patients received fentanyl 2 mcg/kg and induced with propofol 2 mg/kg. Intubation was done following vecuronium 1 mg/kg. Anesthesia was maintained with 66% N2O, 33% O2 and 1% isoflurane. The heart rate (HR) and blood pressure (BP) were measured before induction and thereafter every 15 min up to 2 h. The surgeons were asked to estimate the quality of the operative field using a pre-defined category scale with scores 1-5.Statistical Analysis:Difference within the groups was analyzed using analysis of variance and post-hoc test was used to test the difference between individual groups. Chi-square test was used to find out the association between categorical variables.Results:Comparison of category scale revealed a lower score in Group A up to 60 min. Group B patients showed a statistically lower HR from pre-induction up to 90 min while systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure did not show a significant difference.Conclusions:Oral premedication with 300 mcg of clonidine produced a better operative field than oral metoprolol 50 mg during FESS.

Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study

“…For achieving controlled hypotension, several agents such as nitroglycerine,[ 5 ] higher dose of inhaled anesthetics,[ 6 ] and sodium nitroprusside, such as vasodilator,[ 7 ]β-blocker,[ 8 ] have been used either alone or in combination with each other; however, an ideal agent for inducing controlled hypotension cannot be asserted. The ideal agent used for controlled hypotension must have certain characteristics such as a short onset time, rapid elimination without toxic metabolites, easy to administer, an effect that disappears quickly when administration is discontinued, and dose-dependent predictable effects.…”

Oral clonidine premedication attenuates hemodynamic responses of ketamine during total intravenous anesthesia

“…Oral clonidine 300 μg had also been used successfully to reduce intraoperative bleeding by optimizing hemodynamic parameters during functional endoscopic sinus surgery. [ 10 ] However, we choose to use 150 μg only as there was a concern that use of higher doses might delay patient discharge since our study group comprised day-care patients who were to be discharged on the same day itself.…”

Comparison of dexmedetomidine versus propofol-based anaesthesia for controlled hypotension in functional endoscopic sinus surgery

“…12 The exact mechanism responsible for reducing blood loss is not known, but it may be due to reduction of cardiac output or blood pressure or a combination of both. 13 There are various pharmacological agents that produce deliberate hypotension such as vasodilators (sodium nitroprusside, nicardipine, nitroglycerin), 14 adrenergic beta blockers (propranolol, esmolol, labetalol, metoprolol), 14 magnesium sulphate, 15 inhalational agents (isoflurane, 16 sevoflurane, desflurane 13 ), intravenous α-2 agonists like dexmedetomidine, 17 clonidine, 18 and short-acting opioids like fentanyl or remifentanil. 19 Total intravenous anaesthesia (TIVA) with propofol is also gaining popularity to facilitate controlled hypotension.…”