Deliberate hypotension during functional endoscopic sinus surgery: a comparative study between sodium nitroprusside and dexmedetomidine

Background A randomized, double-blind study was designed to evaluate the efficacy of dexmedetomidine (DEX) as a hypotensive agent in comparison with sodium nitroprusside (SNP) in functional endoscopic sinus surgery (FESS). Patients and methods Sixty patients ASA I, aged 18–60 years, scheduled for FESS were randomly assigned to receive either DEX 1 µg/kg over 10 min before induction of anesthesia, followed by an infusion of 0.2–0.6 µg/kg/h during maintenance of anesthesia (DEX group) or an SNP 0.5–10 µg/kg/min infusion after induction of anesthesia (SNP group) to maintain the mean arterial pressure (MAP) between 50 and 65 mmHg. MAP, heart rate,reversibility of hypotensive state, intraoperative blood loss, and requirement of postoperative analgesia were compared between the two groups. Results The administration of DEX resulted in a significant reduction in MAP and heart rate at preanesthesia (T1), after induction (T2), and 5 min after stopping the hypotensive agent (T4) in comparison with the SNP group. Intraoperative field conditions were significantly better in the DEX group than in the SNP group at 15, 30, and 45 min after the beginning of the surgery. There was a significant reduction in blood loss in the DEX group than the SNP group. Time for first rescue analgesia was significantly longer in the DEX group than the SNP group. Conclusion DEX is an effective and safe agent for controlled hypotension in adults undergoing FESS. It may result in reduced blood loss and a kind of postoperative analgesia.