Comparison between Phentolamine and Nitroglycerin for Controlled Hypotension during Functional Endoscopic Sinus Surgery

Abstract

Background: Intraoperative bleeding is one of the most common complications in Functional endoscopic sinus surgery. Controlled hypotension is a method to minimize surgical blood loss and enhance the operative field visibility. The objective of this study was to compare the efficacy of controlled hypotensive anesthesia with intravenous infusion of phentolamine versus nitroglycerin as regarding intraoperative blood loss and hemodynamic stability. Methods: This current randomized study enrolled 30 patients candidate for Functional endoscopic sinus surgery at Beni-suef university hospital, in 2 equal groups receiving either 0.5 to 10 μg/kg/minute nitroglycerin or 0.1 to 2 mg/minute phentolamine to achieve a mean arterial blood pressure (MAP) of about 50 to 65 mmHg. Mean arterial blood pressure, amount of blood loss and the quality of surgical field using the 0-5 point bleeding scale were recorded. Results: Based on the current study findings, the two drugs produced the desired hypotension on the same time point; there were no significant differences between the study groups regarding the volume of bleeding and operative field visibility. Conclusions: Nitroglycerin and Phentolamine are safe, efficient and might be advisable option for deliberate hypotensive anesthesia throughout Functional endoscopic sinus surgery. Phentolamine can be a good alternative to Nitroglycerin in reduction of MAP during this procedure.