title: Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol.
abstract: OBJECTIVE
  A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery (FESS).
  
  
  METHODS
  Forty patients ASA I or II scheduled for FESS were equally randomly assigned to receive either dexmedetomidine 1 μg/Kg over 10 min before induction of anesthesia followed by 0.4-0.8 μg/Kg/h infusion during maintenance (DEX group), or esmolol, loading dose 1mg/kg was infused over one min followed by 0.4-0.8 mg/kg/h infusion during maintenance (E group) to maintain mean arterial blood pressure (MAP) between (55-65 mmHg). General anesthesia was maintained with sevoflurane 2%-4%. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP and HR); arterial blood gas analysis; plasma cortisol level; intraoperative fentanyl consumption; Emergence time and total recovery from anesthesia (Aldrete score ≥9) were recorded. Sedation score was determined at 15, 30, 60 min after tracheal extubation and time to first analgesic request was recorded.
  
  
  RESULTS
  Both DEX group and E group reached the desired MAP (55-65 mmHg) with no intergroup differences in MAP or HR. The for the quality of the surgical filed in the range of MAP (55-65 mmHg) were <=2 with no significant differences between group scores during hypotensive period. Mean intraoperative fentanyl consumption was significantly lower in DEX group than E group. Cortisol level showed no significant changes between or within groups. No significant changes were observed in arterial blood gases. Emergence time and time to achieve Aldrete score ≥9 were significantly lower in E group compared with DEX group. The sedation score were significantly lower in E group compared with DEX group at 15 and 30 minutes postoperatively. Time to first analgesic request was significantly longer in DEX group.
  
  
  CONCLUSIONS
  Both dexmedetomidine or esmolol with sevoflurane are safe agents for controlled hypotension and are effective in providing ideal surgical field during FESS. Compared with esmolol, dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect.
authors: Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt.
authors: Tarek
authors: T
authors: Shams
authors: Nahla S
authors: NS
authors: El Bahnasawe
authors: Mohamed
authors: M
authors: Abu-Samra
authors: Ragaa
authors: R
authors: El-Masry
keywords: Controlled hypotension; dexmedetomidine; esmolol; functional endoscopic sinus surgery
references: J Clin Anesth. 1993 Nov-Dec;5(6 Suppl 1):64S-68S
references: 8292372
references: Ann Otol Rhinol Laryngol. 2011 Sep;120(9):586-92
references: 22032072
references: J Clin Anesth. 1995 Feb;7(1):89-91
references: 7772368
references: Laryngoscope. 2003 Aug;113(8):1369-73
references: 12897561
references: Plast Reconstr Surg. 2008 Jan;121(1):269-276
references: 18176230
references: J Clin Anesth. 2008 Sep;20(6):431-6
references: 18929283
references: Am J Otolaryngol. 1999 Mar-Apr;20(2):96-101
references: 10203159
references: Anesthesiology. 1993 Jun;78(6):1065-75
references: 8512099
references: Can J Anaesth. 2001 Jan;48(1):20-7
references: 11212044
references: Anaesthesia. 2001 May;56(5):408-13
references: 11350323
references: Can J Anaesth. 2006 Jul;53(7):646-52
references: 16803911
references: Anesth Analg. 1998 Sep;87(3):503-10
references: 9728818
references: Paediatr Drugs. 2002;4(7):439-53
references: 12083972
references: Medicina (Kaunas). 2003;39(9):852-9
references: 14515047
references: Laryngoscope. 1987 Nov;97(11):1270-3
references: 3669837
references: Br Med J. 1974 Jun 22;2(5920):656-9
references: 4835444
references: Anesthesiology. 1997 May;86(5):1055-60
references: 9158354
references: Vasc Endovascular Surg. 2010 May;44(4):257-61
references: 20308169
references: J Clin Anesth. 2008 Sep;20(6):437-41
references: 18929284
references: Br J Anaesth. 2006 Jun;96(6):727-31
references: 16670112
references: J Clin Anesth. 2007 Dec;19(8):576-82
references: 18083469
references: Anesthesiology. 1991 Sep;75(3):499-511
references: 1679615
references: Anesthesiology. 1996 Apr;84(4):873-81
references: 8638842
references: Can J Anaesth. 1995 May;42(5 Pt 1):373-6
references: 7614641
references: Drugs. 2007;67(7):1053-76
references: 17488147
references: Anesthesiology. 1992 Dec;77(6):1134-42
references: 1361311
references: Eur J Appl Physiol Occup Physiol. 1994;69(5):414-20
references: 7875138
references: Anesth Analg. 1991 May;72(5):639-44
references: 1673324
references: Pharmacol Rev. 1980 Dec;32(4):337-62
references: 6267618
references: Eur J Anaesthesiol. 2008 Jan;25(1):22-8
references: 17666131
references: Curr Ther Res Clin Exp. 2007 Mar;68(2):69-81
references: 24678121
references: Otolaryngol Clin North Am. 2010 Aug;43(4):699-730
references: 20599078
references: Eur J Anaesthesiol. 2007 May;24(5):447-53
references: 17241505
references: Eur J Anaesthesiol. 2008 May;25(5):369-74
references: 18294411
references: Anesth Analg. 1986 Jun;65(6):683-6
references: 3706806