Dexmedetomidine Added to Hyperventilation Improves Surgical Field Visibility Without Compromising Cerebral Oxygenation During Endoscopic Sinus Surgery

Background Optimal surgical field visibility is essential during endoscopic sinus surgery (ESS), yet strategies that reduce bleeding may raise concern about impaired cerebral oxygenation. We evaluated whether adding dexmedetomidine to hyperventilation improves surgical field visibility during ESS without compromising cerebral oxygenation. Methods In this double‐blinded randomized controlled trial, 74 patients with chronic rhinosinusitis undergoing ESS were randomly assigned to receive dexmedetomidine plus hyperventilation or hyperventilation alone. The primary endpoint was the Boezaart surgical field score assessed 30 min after the start of surgery. Secondary endpoints were intraoperative cerebral oxygen saturation (ScO 2 ), bleeding rate, hemodynamic variables, anesthetic consumption, and postoperative recovery outcomes. Results Compared with hyperventilation alone, dexmedetomidine plus hyperventilation improved surgical field visibility, with a lower Boezaart score at 30 min after surgery onset (2.0 (1.0–2.0) vs. 3.0 (2.0–3.0), p = 0.003). Longitudinal analysis further demonstrated that dexmedetomidine plus hyperventilation was associated with lower odds of poorer surgical field scores over time (OR = 0.180, 95% CI, 0.062–0.524; p = 0.002). The bleeding rate was lower with dexmedetomidine plus hyperventilation, whereas intraoperative ScO 2 was comparable between groups and no cerebral desaturation events occurred. Conclusions In patients undergoing ESS, adding dexmedetomidine to hyperventilation improved surgical field visibility without compromising intraoperative cerebral oxygenation. This combined strategy may help optimize operative conditions in ESS.