COMPARATIVE EVALUATION OF THE EFFICACY OF DEXMEDETOMIDINE VERSUS ESMOLOL FOR CONTROLLED HYPOTENSION IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY

Abstract

Background: Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure designed to restore normal drainage and function of the paranasal sinuses. However, FESS performed under general anesthesia has been reported to be associated with major complications, primarily resulting from impaired visibility due to excessive bleeding.

Aim: To compare the efficacy of dexmedetomidine and esmolol as hypotensive agent for  controlled hypotensive anesthesia in functional endoscopic sinus surgery with regards to inducing dry surgical field, duration of post-operative analgesia and sedation, and adverse effects.

Methods: This longitudinal prospective comparative study included patients aged 25-55 years undergoing elective FESS under general anesthesia. Participants were randomly assigned to two groups: Group D received dexmedetomidine, and Group E received esmolol. Data were collected on intraoperative parameters such as heart rate, blood pressure, oxygen saturation, and surgical field quality. Postoperative parameters included the duration of analgesia and sedation, and the incidence of adverse effects. Statistical analysis was performed using SPSS software.

Results: The dexmedetomidine group had significantly lower intraoperative fentanyl consumption and a longer time to the first analgesic request postoperatively compared to the esmolol group. The quality of the surgical field, assessed by the absence of an obscured field, was significantly better in the esmolol group, with only 10% of cases reporting an obscured field compared to 40% in the dexmedetomidine group.  Intraoperative blood loss was significantly higher in the dexmedetomidine group. However, the dexmedetomidine group exhibited better postoperative sedation scores, though they experienced higher incidences of bradycardia and hypertension. The esmolol group had faster recovery times and lower postoperative sedation scores. Both drugs were effective for controlled hypotension during FESS, but esmolol provided a clearer surgical field and quicker recovery, while dexmedetomidine offered better postoperative analgesia and sedation.

Conclusion: This study concluded that both dexmedetomidine and esmolol are effective for controlled hypotension during FESS. Dexmedetomidine provided better postoperative analgesia and sedation but was associated with higher intraoperative blood loss and more frequent adverse effects such as bradycardia and hypertension. Esmolol offered a clearer surgical field and faster recovery with fewer adverse effects, making it a preferable choice for patients where rapid recovery and minimal postoperative complications are prioritized.