Key result
Esmolol and dexmedetomidine were equally effective in achieving controlled hypotension and minimizing intraoperative blood loss during functional endoscopic sinus surgery, though dexmedetomidine prolonged emergence time and time to first rescue analgesic.
Why the study?
Intraoperative bleeding during FESS impairs surgical visibility, and while controlled hypotensive anesthesia with esmolol or dexmedetomidine is used to mitigate blood loss, their comparative efficacy and safety needed evaluation.
Does esmolol compared to dexmedetomidine improve controlled hypotension and recovery in patients undergoing functional endoscopic sinus surgery?
RCT (n=60)
Double-blind
Sealed envelope method
No
Does esmolol compared to dexmedetomidine improve controlled hypotension and recovery in patients undergoing functional endoscopic sinus surgery?
Absolute Event Rate: 137.17% vs 138.1%
p-value: p=0.598
Both esmolol and dexmedetomidine are effective for achieving controlled hypotension during FESS, with esmolol allowing for faster recovery and dexmedetomidine providing superior postoperative analgesia.
Both agents offer comparable hemodynamic control and blood loss reduction in FESS; confirms equivalence for primary efficacy while highlighting recovery and analgesia trade-offs.
Objective: Functional Endoscopic Sinus Surgery (FESS) is a prevalent procedure in otorhinolaryngology, often complicated by excessive intraoperative bleeding, which impairs surgical visibility. Controlled hypotensive anesthesia is employed to mitigate blood loss and enhance the surgical field. Esmolol, an ultra-short-acting beta-blocker, and Dexmedetomidine, a selective α₂-adrenergic agonist, are two agents commonly used to achieve controlled hypotension. This study aims to compare the efficacy and safety of esmolol versus dexmedetomidine in maintaining controlled hypotension during FESS. Methods: A prospective, double-blind, randomized interventional study was conducted involving 60 patients aged 18-65 years with ASA Grade I-II, scheduled for FESS under general anesthesia. Participants were randomly allocated into two groups: Group A received an esmolol bolus of 1 mg/kg over 1 minute followed by an infusion of 1 mg/kg/h, while Group B received a dexmedetomidine bolus of 1 µg/kg over 10 min followed by an infusion of 0.5 µg/kg/hr. Hemodynamic parameters, blood loss, duration of surgery, quality of the surgical field, recovery time, analgesic requirements, and complications were recorded and analyzed. Results: Both esmolol and dexmedetomidine groups achieved significant reductions in mean arterial pressure (MAP) without significant differences between the groups. Blood loss and duration of surgery were comparable. Dexmedetomidine was associated with a significantly longer time to first rescue analgesic (58.7±5.09 min vs. 29.83±4.38 min, p<0.001) and prolonged emergence time (7.45±0.98 min vs. 4.45±0.97 min, p<0.001) compared to esmolol. Heart rate was significantly lower in the dexmedetomidine group throughout the surgery (p<0.001). Complication rates were similar between groups. Conclusion: Both esmolol and dexmedetomidine are effective and safe for achieving controlled hypotension in FESS, providing hemodynamic stability and minimal blood loss. Dexmedetomidine offers superior postoperative analgesia but is associated with delayed emergence, whereas esmolol allows for quicker recovery. Choice of agent can be tailored based on patient-specific requirements and surgical considerations.
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Sharma et al. (2025) conducted an RCT in Patients scheduled for Functional Endoscopic Sinus Surgery (FESS) (n=60). Esmolol vs. Dexmedetomidine (1 µg/kg bolus over 10 min followed by 0.5 µg/kg/hr infusion) was evaluated on Intraoperative blood loss (ml) (p=0.598). Esmolol and dexmedetomidine were equally effective in achieving controlled hypotension and minimizing intraoperative blood loss during functional endoscopic sinus surgery, though dexmedetomidine prolonged emergence time and time to first rescue analgesic.
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