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.Materials and 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.Conclusion:Dexmedetomidine found to be providing more effectively controlled hypotension and analgesia and thus allowing less nasal bleeding as well as more surgeons’ satisfaction score.

The effect of low central venous pressure on hepatic surgical field bleeding and serum lactate in patients undergoing partial hepatectomy: a prospective randomized controlled trial

“…Blood loss caused by oozing from the resected liver When decreasing CVP using nitroglycerin and esmolol, SBP decreased by approximately 10 mmHg in Group L compared with Group F. However, neither the severity of bleeding in the hepatic surgical field nor the intraoperative blood loss was related to arterial blood pressure in this study. Deliberately inducing hypotension by lowering arterial blood pressure can decrease the degree of bleeding in areas of the surgical field other than the liver surface [17,18,24]. In the present study, lower arterial blood pressure was not associated with the bleeding score of the surgical field or intraoperative blood loss, possibly because 60 to 80% of the blood supply is from the portal vein.…”

“…Adverse events such as postoperative delirium, delayed recovery, urine output of <20 ml/h, and emergence agitation were recorded. The bleeding score of the hepatic surgical field ( Table 1) was determined as described by Fromme et al [17] and Das et al [18]. The same surgeon, who was blinded to the group assignment, assessed hepatic surgical field bleeding.…”

“…The sample size was calculated using a test for two ordered categorical variables with a randomization ratio of 1:1, two-sided significance level of 0.05, and power of 0.8. According to the data in the trials by Ryu et al [13] and Das et al [18], the control group category proportions were 0.1, 0.2, 0.4, 0.2, and 0.1, and the logarithm of the odds radio of the treatment group was assigned a value of 0.9. We determined that 64 patients would be required in each group, and we recruited 70 patients in each group to address patients possibly leaving the study.…”

Meta-analysis of the effects of dexmedetomidine vs esmolol for used controlled hypotension during surgery

“…A total of 115 articles were retrieved from three databases After excluded duplicating, The remaining 75 articles were identi ed for further assessment. In the end, eight RCTs were included [8][9][10][11][12][13][14][15] .…”

Effect of dexmedetomidine combined with lumbar anesthesia on Th1/Th2 in maternal patients and neonates undergoing caesarean section

“…The pharmacological effects of dexmedetomidine include anxiolytic, sedative, analgesic, hypnotic and sympathetic blockade. The US Food and Drug Administration approved the use of dexmedetomidine in mechanical ventilation patients in the adult intensive care unit, as well as in pediatrics, neurosurgery and fiberoptic bronchoscopy for cardiovascular surgery (15,16). The application of dexmedetomidine may affect the immune system of the maternal patient and neonate (17).…”