Abstract
Introduction: During functional endoscopic sinus surgery (FESS), effective control of bleeding is essentialto maintain a clear operative field and to minimize complications. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Study was designed to compare dexmedetomidine-isoflurane versus fentanyl-propofol based anesthesia in FESS surgery and to determine whether controlled hypotension and better operative conditions can be achieved when compared to each other. Methods: Prospective randomized study includes a total of 60 ASA I-II patients who underwent elective FESS surgery. Patients randomly assigned in two groups Dexmedetomidine-Isoflurane (DI) and Fentanyl-Propofol (FP). Intraoperative mean arterial pressure (MAP), heart rate (HR) and surgical grade of bleeding (based on Fromme-Boezzart scale) were recorded. Results and conclusion: This study demonstrated that Controlled hypotension can be achieved equally and effectively by both Dexmedetomidine- Isoflurane and Fentanyl-Propofol based anesthesia. Both are equally effective in providing ideal surgical field during FESS. MAP and heart rate were significantly higher at some occasion in FP group as compare to DI group.
Highlights
During functional endoscopic sinus surgery (FESS), effective control of bleeding is essential to maintain a clear operative field and to minimize complications
mean arterial pressure (MAP) at induction and after 10 minutes were significantly lower in DI group as compare to FP group with P value of 0.0001 and 0.029 respectively
Isoflurane usage in high concentration during FESS may increase perfusion of the nasal mucous membrane and surgical bleeding as well[12].As in previous studies higher end tidal isoflurane concentration was used as a conventional technique to achieve controlled hypotension, which had led to increase bleeding or delayed recovery[5].In group DI we had restricted the maximum end tidal isoflurane concentration to only 1%, as simultaneous use of dexmedetomidine infusion decrease the requirement of other anaesthestic agents[8]
Summary
During functional endoscopic sinus surgery (FESS), effective control of bleeding is essential to maintain a clear operative field and to minimize complications. Study was designed to compare dexmedetomidine-isoflurane versus fentanyl-propofol based anesthesia in FESS surgery and to determine whether controlled hypotension and better operative conditions can be achieved when compared to each other. Results and conclusion: This study demonstrated that Controlled hypotension can be achieved and effectively by both Dexmedetomidine Isoflurane and Fentanyl-Propofol based anesthesia. Both are effective in providing ideal surgical field during FESS. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Various agents such as beta adrenergic antagonist, nitroglycerine, high doses of potent inhaled anesthetics, alpha-2 agonist and magnesium sulfate have been used to achieve controlled hypotension[1, 2, 3]
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