Comparison of dexmedetomidine with nitroglycerinefor hypotensive anaesthesia in functional endoscopic sinus surgery
Authors: Praveen DV, Pushparani A, Anand K, Balachandran Sundaraperumal, Umadevi.
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Aim: The aim of the study is to compare Dexmedetomidine with Nitroglycerine for hypotensive anaesthesia for Functional Endoscopic Sinus Surgeries (FESS) with respect to quality of the surgical field, hemodynamics, amount of blood loss, intraoperative opioid requirement, time to first analgesic request and recovery profile.
Methods: After approval by institutional Ethics Committee, 60 patients were randomly allocated by sealed envelope technique into two drug groups: Nitroglycerine (Group N) and Dexmedetomidine (Group D). After induction of anesthesia, Nitroglycerine infusion at 0.5-10 µg/kg/min was started for patients in group N and Dexmedetomidine was given as loading dose of 1 µg/kg over 10 min followed by maintenance infusion rate of 0.2- 0.7 µg/kg/hr for patients in group D. The infusion rates were then titrated to maintain MAP between 50-60 mm of Hg or 30% reduction of baseline MAP, whichever is higher. Parameters observed include heart rate, mean arterial pressure, blood loss (Average Category Scale), emergence time, time to first rescue analgesic and post-operative recovery (Modified Alderete Score).
Results: In our study, statistically significant reduction in heart rate (58/min vs 69/min) was observed in patients in group D, while Systolic, diastolic and mean arterial pressure were comparable. The quality of surgical field as assessed by ACS was better in group D (p<0.05, significant). Patients in group D also needed less intraoperative opioid compared to group N (139.33mcg vs 187.67mcg and prolonged time to first rescue analgesic (377.33 sec vs 86 sec). However, emergence time (20.6sec vs 14.0 sec) and recovery profile using time to reach MAS? 9 was better in group N. Patients in group N also had better sedation scores compared to group D (2.2 vs 1.43).
Conclusion: Dexmedetomidine was better compared to Nitroglycerine for hypotensive anaesthesia in Functional Endoscopic Sinus Surgery with respect to quality of surgical field as assessed by average category scale, less intra operative opioid requirement and prolonged time to first rescue analgesic post operatively. However, Nitroglycerine was better with respect to early emergence from anaesthesia and early discharge criteria as assessed by modified Alderete s