Induced Hypotension in Functional Endoscopic Sinus Surgery: A Comparative Study of Dexmedetomidine and Esmolol

Abstract

Introduction Functional endoscopic sinus surgery (FESS) is one of the common surgical procedures requiring hypotensive anesthesia; many agents have been tried to reduce the amount of blood loss. This study aims at comparing the efficacy of two agents for providing deliberate hypotension. Objectives The aim of this study was to evaluate the efficacy of esmolol and of dexmedetomidine and compare which one of the two is a better agent to produce induced hypotension during FESS. Materials and methods This was a comparative study conducted in a tertiary care hospital in Odisha, India. There were two study groups with 30 participants each who were given either esmolol or dexmedetomidine (group E and group DEX, respectively). Results Esmolol is an anti-hypertensive agent with better hemodynamic stability. The amount of drug and dose requirement was low in group DEX. The emergence time, sedation score, and time to first analgesic request were found to be highly statistically significant in group DEX. Conclusion Dexmedetomidine was found to be a better agent at controlling intra-operative blood pressure than esmolol and had beneficial effects on recovery from anesthesia and analgesia.

Nalbuphine’s Hemodynamic Impact in Ear, Nose, and Throat (ENT) Surgeries: A Comprehensive Review

“…However, it is imperative to uphold hemodynamic stability throughout the intraoperative period. A study that compared the utilization of dexmedetomidine and esmolol revealed that dexmedetomidine, functioning as an alpha-2 adrenergic agonist, exhibited superior efficacy in maintaining hemodynamic stability, particularly noted during FES surgery [ 5 ].…”

“…Monitoring hemodynamic parameters: Rigorous monitoring of hemodynamic parameters, such as blood pressure, heart rate, and oxygen saturation, is indispensable during ENT surgeries. This meticulous observation ensures patient safety and facilitates the early detection of any deviations in hemodynamic status [ 5 ]. Such vigilant monitoring is crucial for timely interventions and contributes significantly to ENT procedures' overall success and safety.…”

“…The field of ear, nose, and throat (ENT) surgeries poses unique challenges, with procedures ranging from routine tonsillectomies to intricate rhinoplasties and functional endoscopic sinus (FES) surgeries [ 3 - 5 ]. Particularly in these cases, achieving controlled hypotension is often imperative.…”

“…The proximity of vital structures, intricate vascular anatomy, and the potential for bleeding make vigilant control over blood pressure and heart rate essential to mitigate complications and optimize patient outcomes [ 4 ]. It is noteworthy that procedures such as routine tonsillectomies, rhinoplasties, and FES surgeries may specifically demand hypotensive anesthesia [ 3 - 5 ].…”

Controlled Hypotension for Functional Endoscopic Sinus Surgery With Two Different Doses of Fentanyl

“…However, often prescribed hypotensive drugs can have unpleasant side effects, including heart blocks, rebound hypertension, tachyphylaxis, drowsiness, delayed recovery, and vasodilatation (halogenated substances, nitrates, and beta blockers, among others) [8][9][10][11]. These drugs are employed to provide a surgical field free of blood by achieving controlled hypotension [12][13][14][15].…”