title: Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study.
abstract: BACKGROUND
  Functional endoscopic sinus surgery (FESS) is the cornerstone of therapeutic management for nasal pathologies. This study is to compare the ability of preoperative and intraoperative esmolol versus dexmedetomidine for producing induced hypotension during FESS in adults in a day care setting.
  
  
  METHODS
  Sixty patients (20-45 years) posted for FESS under general anesthesia were randomly divided into Group E (n = 30) receiving esmolol, loading dose 1 mg/kg over 1 min followed by 0.5 mg/kg/h infusion during maintenance and Group D (n = 30) receiving dexmedetomidine 1 μg/kg over 15 min before induction of anesthesia followed by 0.5 μg/Kg/h infusion during maintenance, respectively. Nasal bleeding and Surgeon's satisfaction score; amount and number of patients receiving fentanyl and nitroglycerine for analgesia and deliberate hypotension, Postanesthesia Care Unit (PACU) and hospital stay; hemodynamic parameters and side effects were recorded for each patient.
  
  
  RESULTS
  Significantly less number and dosage of nitroglycerine was required (P = 0.0032 and 0.0001, respectively) in Group D compared to that in Group E. Again the number and dosage of patients requiring fentanyl were significantly lower in Group D. However, the duration of controlled hypotension was almost similar in both the groups. Group D patients suffered from significantly less nasal bleeding, and surgeon's satisfaction score was also high in this group. Discharge from PACU and hospital were significantly earlier in Group D. Intraoperative hemodynamics were quite comparable (P > 0.05) without any appreciable side effects.
  
  
  CONCLUSIONS
  Dexmedetomidine found to be providing more effectively controlled hypotension and analgesia and thus allowing less nasal bleeding as well as more surgeons' satisfaction score.
authors.affiliation: Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India.
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India.
authors.forename: S
authors.initials: S
authors.lastname: Chhaule
authors.affiliation: Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India.
authors.forename: S
authors.initials: S
authors.lastname: Bhattacharya
authors.affiliation: Department of Anesthesiology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India.
authors.forename: S R
authors.initials: SR
authors.lastname: Basunia
authors.affiliation: Department of Anesthesiology, Murshidabad Medical College, Berhampore, West Bengal, India.
authors.forename: T
authors.initials: T
authors.lastname: Mitra
authors.affiliation: Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India.
authors.forename: P S
authors.initials: PS
authors.lastname: Halder
authors.affiliation: Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India.
authors.forename: S
authors.initials: S
authors.lastname: Chattopadhyay
authors.affiliation: Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Mandal
keywords: Ambulatory (day care); dexmedetomidine; esmolol; functional endoscopic sinus surgery; heart rate; mean arterial pressure