To Compare the Efficacy of Dexmedetomidine Versus Labetalol in Providing Controlled Hypotension in Functional Endoscopic Sinus Surgery

Abstract

Background: Functional endoscopic sinus surgery (FESS) is a surgical intervention for sinus diseases. Bleeding is a common concern during FESS. Hemodynamic stability and quality surgical field visibility help to achieve the best outcomes. Objectives: The present study primarily intended to compare the effectiveness of dexmedetomidine versus labetalol in providing controlled hypotension during FESS and then to assess the quality of the surgical field. Methods: The current research was conducted as a prospective randomized double-blinded clinical study. Sixty patients of the American Society of Anesthesiologists grade I or II status undergoing FESS under general anesthesia were divided into two groups, each with 30 members. Patients receiving dexmedetomidine and labetalol were named as group D and L, respectively. The study intended to manage mean arterial pressure (MAP) between 65 - 75 mmHg. The visibility of the operative field was evaluated using Fromme and Boezaart scoring system. Total intraoperative fentanyl consumption and postoperative first analgesic request time were recorded. Results: The MAP target was achieved in both groups. Intergroup differences concerning MAP were observed in both D (75.0 ± 2.0) and L (82.4 ± 5.2) groups (P-value < 0.05). Scores for blood loss were significantly lower in the D group (1.3 ± 0.3) compared to the L group (2.1 ± 0.3) (P-value < 0.05). There was no intergroup difference concerning the mean heart rate (group D; 70.8 ± 4.2, and group L; 73.4 ± 4.4). The total dose of fentanyl consumed was found to be significantly lower in the group D (41.9 ± 5.8) compared to group L (59.9 ± 5.3) (P-value < 0.05). The first analgesic request time was significantly longer in the group D (50.2 ± 9.1) compared to group L (24.8 ± 5.1) (P-value < 0.05). Conclusions: Dexmedetomidine provided better hemodynamic stability and operative field visibility as compared to labetalol during FESS.

Efficacy of Dexmedetomidine Infusion Without Loading Dose on Hemodynamic Variables and Recovery Time During Craniotomy: A Randomized Double-blinded Controlled Study

“…For 5) noticed a significant reduction of intraoperative -BIS guided-fentanyl and propofol utilization in patients undergoing cerebellopontine angle surgeries. Also, the same finding is consistent with studies done on other types of surgeries (23,24). In dis-concordance to our results, Sriganesh and their colleagues (6,7) demonstrated that a dexmedetomidine infusion of 0.5 µg/kg/h without loading dose was not superior to fentanyl.…”

“…For example, Chakrabati et al ( 5 ) noticed a significant reduction of intraoperative -BIS guided- fentanyl and propofol utilization in patients undergoing cerebellopontine angle surgeries. Also, the same finding is consistent with studies done on other types of surgeries ( 23 , 24 ).…”

Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review

“…tion, dexmedetomidine has also been used for sedation during awake fibreoptic intubation (16), reducing emergence delirium in children for strabismus surgery (17), premedicating children undergoing dental procedures (18), reducing the hemodynamic changes during elective colonoscopy (19), improving post-cesarean analgesia (20), sedating patients for closed reduction of nasal fractures (21), providing controlled hypotension during functional endoscopic sinus surgery (22), and reducing postoperative cognitive dysfunction (POCD) after middle ear surgery under hypotensive technique (23). Dexmedetomidine has also been used more importantly as an adjuvant to improve chronic and neuropathic pain and prolong the effects of chronic pain procedures (24).…”

Effect of Different Loading Doses of Dexmedetomidine on Controlled Hypotension and the Incidence of Bradycardia During Rhinoplasty: A Clinical Trial

“…Different types of drugs have been investigated to provide "controlled hypotension" during surgeries, including opioids (9)(10)(11)(12), beta-blockers (13,14), vasodilators (15,16), and α2-adrenoreceptor agonists (9,11,12,14,17). Dexmedetomidine, an α2-agonist, has been used as a sedative (18)(19)(20), anxiolytic (21), and hypotensive (22,23) agent for anesthesia.…”

“…The decrease in cardiac output is due to a negative chronotropic effect of dexmedetomidine, and the systolic and diastolic function is not impaired (34). The hypotensive and heart ratereducing properties of this agent make it a reasonable choice for procedures requiring "controlled hypotension", and it has been demonstrated to have favorable effects compared to other drugs in this regard (9,11,12,14,17). Furthermore, the administration of dexmedetomidine during operation is associated with a decrease in the incidence of postoperative shivering, nausea, vomiting, delirium, and postoperative cognitive dysfunction (35)(36)(37).…”