title: A comparison of effects of oral premedication with clonidine and metoprolol on intraoperative hemodynamics and surgical conditions during functional endoscopic sinus surgery.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  The aim of this study was to compare the hemodynamic changes and surgical conditions during FESS following oral premedication with clonidine and metoprolol.
  
  
  METHODS
  A total of 40 patients undergoing FESS were included in this prospective, randomized controlled study.
  
  
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Nitu
authors.initials: N
authors.lastname: Puthenveettil
authors.affiliation: Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Suresh Gangadharan
authors.initials: SG
authors.lastname: Nair
keywords: Functional endoscopic sinus surgery; oral clonidine; oral metoprolol; surgical field