title: A Comparison of the Effects of Esmolol and Dexmedetomidine on the Clinical Course and Cost for Controlled Hypotensive Anaesthesia.
abstract: OBJECTIVE
  To compare the effects of esmolol (β-blocker) and dexmedetomidine (α-2-agonist) on patients' clinical course and cost of application of controlled hypotension during middle-ear surgery.
  
  
  METHODS
  Fifty ASA I-II patients scheduled for tympanomastoidectomy were enrolled in the study and were randomized into two groups. Bispectral Index (BIS) and neuromuscular monitoring (TOF GUARD-SX) were applied to all patients. In group E (n=25), 0.5 mg kg(-1) min(-1) esmolol was infused over 1 min before induction and titrated over a range of 10-200 μg kg(-1) min(-1); in group D (n=25), 0.5 μg kg(-1) dexmedetomidine was infused over 10 minutes before induction, and then titrated over a range of 0.2-0.7 μg kg(-1) hr(-1) to maintain mean arterial pressure (MAP) between 55 and 65 mmHg and BIS 40-50 after induction. In both groups, 0.25 μg kg(-1) min(-1) remifentanil infusion was used for anaesthesia maintenance. Maintaining end-tidal CO2 (EtCO2) at 35-40, using 1 MAC sevoflurane in 50% O2-air mixture, mechanical ventilation was started. The effects of both agents on hemodynamic conditions [(heart rate (HR), mean arterial pressure (MAP)], neuromuscular blockage [onset of action (OA), duration of clinical action (DCA), recovery index (RI)], amount of bleeding, surgeon satisfaction, and total dexmedetomidine and esmolol doses used during the intervention were recorded and costs were compared between the groups.
  
  
  RESULTS
  No significant difference was present in hemodynamic conditions, bleeding scores or surgeon satisfaction between groups. Although OA was similar in both groups, DCA and RI were significantly higher in group D. Cost was significantly higher with esmolol than dexmedetomidine.
  
  
  CONCLUSIONS
  We conclude that although both agents are feasible in inducing hypotensive anaesthesia, while neuromuscular block time prolonged by using dexmedetomidine, higher costs were observed with esmolol.
authors.affiliation: Van Erciş State Hospital, Van, Turkey.
authors.forename: Zeynel Abidin
authors.initials: ZA
authors.lastname: Erbesler
authors.affiliation: Department of Anaesthesiology and Reanimation, Ministry of Health Ümraniye Training and Research Hospital, İstanbul, Turkey.
authors.forename: Nurten
authors.initials: N
authors.lastname: Bakan
authors.affiliation: Department of Anaesthesiology and Reanimation, Ministry of Health Ümraniye Training and Research Hospital, İstanbul, Turkey.
authors.forename: Gülşah Yılmaz
authors.initials: GY
authors.lastname: Karaören
authors.affiliation: Department of Anaesthesiology and Reanimation, Ministry of Health Ümraniye Training and Research Hospital, İstanbul, Turkey.
authors.forename: Muhammet Ali
authors.initials: MA
authors.lastname: Erkmen
keywords: Anesthesia; controlled hypotension; dexmedetomidine; esmolol; middle ear surgery