Controlled Hypotension in Rhinoplasty Surgery: Mechanisms, Techniques, and Clinical Considerations; A Narrative Review

Background: Controlled hypotension is a commonly employed anesthetic technique in rhinoplasty aimed at reducing intraoperative bleeding and improving surgical field visibility. Despite its widespread use, there remains variability in the choice of pharmacological agents and clinical protocols. Aim: This narrative review provides a comprehensive overview of the mechanisms, pharmacological techniques, and clinical considerations involved in controlled hypotension for rhinoplasty. Methods: Key studies, clinical trials, and systematic reviews published on controlled hypotension agents including dexmedetomidine, esmolol, magnesium sulfate, and remifentanil were analyzed and synthesized. Results: Controlled hypotension effectively decreases intraoperative blood loss and enhances surgical conditions. Dexmedetomidine offers stable hemodynamics with sedative and analgesic benefits, while esmolol and remifentanil allow rapid and titratable blood pressure control. Magnesium sulfate serves as an adjunct with vasodilatory and neuroprotective effects. Careful patient selection and continuous hemodynamic monitoring are critical to minimize adverse events. Conclusion: When applied judiciously, controlled hypotension is a valuable strategy in rhinoplasty anesthesia, improving surgical outcomes and patient safety. Future research should focus on optimizing drug combinations and protocols to further enhance efficacy and minimize risks.