Controlled Hypotensive Anesthesia in Children Undergoing Nasal Surgery

Abstract

Background: The nasal surgery in pediatric patient’s caries a major challenge to both anesthesiologist and surgeon. The surgeon faces small nostrils and narrow nasal passages. The anesthesiologist has to produce condition which facilitate the surgery, decrease the operative time by minimize the intraoperative bleeding to allow better visualization this can be achieved by controlled hypotensive anesthesia which is the key issue in the success of nasal surgery in pediatric age group. Patient and methods: Seventy pediatric patients aged 8-12 years scheduled for elective nasal surgery under general anesthesia. Patients were classified into two equal groups (35 patients per group) according to study drugs used. Group (D): The patients in this group received dexmedetomidine 0.5 μg/kg as loading dose over 10 minutes followed by 0.2-0.5 μg/kg/h as maintenance infusion after induction of anesthesia but before surgery. Group (E): The patients in this group received esmolol 0.5 mg/kg as loading dose over 10 minutes followed by 100-300 μg/kg/min as maintenance infusion after induction of anesthesia but before surgery. Measurements: Heart rate, Mean Arterial blood Pressure, Quality of surgical field, duration of surgery, duration of anesthesia, Aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea, serum creatinine, adverse events and postoperative analgesia. Results: There were no significant differences between groups as regards to demographic data, duration of surgery, and duration of anesthesia. The MABP and HR were significantly decreased after infusion of study drugs till the end of surgery with no differences between both groups in all times of measurements. The quality of surgical field was comparable between both groups in all times of measurements. There were no changes in blood urea, serum creatinine, AST, and ALT. Conclusion: Our study demonstrated that both dexmedetomidine and esmolol are safe and effective agents for inducing controlled hypotension in pediatric patients undergoing nasal surgery with no reported complications.