Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery

Abstract

Background and Aims: Excessive bleeding is a major concern in functional endoscopic sinus surgery (FESS) under general anaesthesia; this can be decreased by various hypotensive agents. This study was conducted to compare the hypotensive effectiveness and haemodynamic stability of dexmedetomidine and clonidine in patients undergoing elective FESS. Methods: In this prospective double-blinded interventional study, 70 adult patients of either sex, 20–50 years of age, posted for elective FESS were randomly assigned to two groups. Group A received a loading dose of intravenous (IV) dexmedetomidine 1 μg/kg, followed by infusion of 1 μg/kg/h, and group B received a loading dose of IV clonidine 2 μg/kg, followed by 1 μg/kg/h infusion. Surgical field quality, emergence time, sedation score, visual analogue score, recovery profile and haemodynamic parameters were recorded. Statistical analysis was done by Student's unpaired t -test to evaluate the significance of normally distributed variables, whereas Mann–Whitney test and Chi-square test were used for ordinal data and categorical variables and proportions, respectively. Results: In both the groups, target mean arterial pressure (MAP) of 65–70 mmHg and improved surgical field quality were achieved. MAP and heart rate (HR) were statistically significantly lower in the dexmedetomidine group with a longer duration of post-operative analgesia ( P = 0.001). None of the groups showed any statistically significant adverse effects. Conclusions: Both dexmedetomidine and clonidine can be used for controlled hypotension to improve surgical field quality in FESS. Dexmedetomidine provides more haemodynamic stability and an additional benefit of post-operative analgesia and conscious sedation.

Comparative study between Dexmedetomidine, magnesium sulfate and propofol in controlled hypotensive anesthesia during endoscopic sinus surgery

“…Controlled hypotension plays a crucial role in FESS by effectively reducing intraoperative enhancing visibility quality and bleeding of the surgical site [9] . In accordance with our findings, Rokhtabnak et al [10] concurred on the topic of bleeding, surgeon satisfaction and visibility in the field of surgical.…”

Effect of Intravenous Aminophylline on Hemodynamics and Recovery of Patients Undergoing Functional Endoscopic Sinus Surgery Under Dexmedetomidine Hypotensive Anesthesia: A Randomized Controlled Study

“…These beneficial effects of DEX made it a desirable option for establishing hypotensive anesthesia during FESS (10)(11)(12). However, most studies that used DEX during FESS reported delayed emergence from anesthesia and higher postoperative sedation with or without delay in a postanesthesia care unit (PACU) discharge time (13)(14)(15)(16).…”

Impact of Intraoperative Degrees of Hypotensive Anaesthesia Using Dexmedetomidine on Perioperative Renal Injuries in Patients Undergoing Endoscopic Sinus Surgery

“…Controlled hypotension could precipitate serious perioperative consequences, including acute kidney injury [AKI], hypoperfusion or ischemia to other vital organs, and acidosis [4] . That's why identification of the risk factors for that problem is crucial for its prevention [5] .…”