Published: 2022-10-28

Induced hypotension for functional endoscopic sinus surgery: comparison between dexmedetomidine and nitro-glycerine

Habib Rahaman A. A., Dhananjaya Kumar S. M., Amulya N., Geetanjali M., Kiran Kumar O.


Background: Functional endoscopic sinus surgery (FESS) is a minimally invasive technique used to restore sinus ventilation and normal function by opening sinus air cells and ostia. FESS requires bloodless field, several techniques and drugs have been used in the past for achieving controlled hypotension such as nitroglycerine, esmolol, remifentanil, dexmedetomidine, isoflurane, propofol. Therefore, this study was conducted to compare between dexmedetomidine and nitroglycerine for controlled hypotension for FESS. Primary aim to compare quality of surgical field using average category scale and surgeon satisfaction and secondary aim to compare arterial pressure and heart rate changes between dexmedetomidine and nitroglycerine when used to induce hypotension.

Methods: This study was conducted in 40 consenting adult patients posted for FESS and were randomly divided into two groups, group D received dexmedetomidine 1 mcg/kg and group N received nitroglycerine 0.5 mcg/kg/min, both infusions started 10 min after induction. Parameters such as quality of surgical field by average category scale, heart rate and mean arterial pressure (MAP) recorded every 10 minutes.

Results: Dexmedetomidine and nitroglycerine both had comparable quality of surgical field. ACS grading of 1 or 2 were found among both the groups. Dexmedetomidine group had better mean arterial pressure at 10th, 20th, 30th, 40th, 50th, 60th and 70th min and heart rate at 10th, 20th, 30th, 40th, 50th, 60th and 70th min when compared to nitroglycerine group.

Conclusions: Dexmedetomidine and nitroglycerine both were found to be safe to use for controlled hypotension in functional endoscopic sinus surgeries.


FESS, Controlled hypotension, Dexmedetomidine, Nitroglycerine

Full Text:



Dalziel K, Stein K, Round A, Garside R, Royle P. Systematic review of endoscopic sinus surgery for nasal polyps. In NIHR Health Technology Assessment programme: Executive Summaries. NIHR J Library. 2003.

Das A, Chhaule S, Bhattacharya S, Basunia SR, Mitra T, Halder PS, Chattopadhyay S, Mandal SK. Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study. Saudi J Anaesthesia. 2016;10(3):276-82.

Bajwa SJ, Kaur J, Kulshrestha A, Haldar R, Sethi R, Singh A. Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation. J Anaesthesiol Clin Pharmacol. 2016;32(2):192-7.

Rahman NI, Fouad EA, Ahmed A, Youness AR, Wahib M. Efficacy of different dexmedetomidine regimens in producing controlled hypotensive anaesthesia during functional endoscopic sinus surgery. Egypt J Anaesthesia. 2014;30(4):339-45.

Chiruvella S, Balaji Donthu VS, Babu D. Controlled hypotensive anaesthesia with dexmedetomidine for functional endoscopic sinus surgery: a prospective randomized double blind study. J Evol Med Dental Sci. 2014;3(37):9556-63.

Jacobi KE, Böhm BE, Rickauer AJ, Jacobi C. Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood BIBLIOGRAPHY Page 67 loss in endoscopic sinus surgery. J Clin Anaesthesia. 2000;12(3):202-7.

Mishra A, Singh RB, Choubey S, Tripathi RK, Sarkar A. A comparison between nitroprusside and nitroglycerine for hypotensive anaesthesia in ear, nose, and throat surgeries: A double-blind randomized study. Med J Dr. DY Patil University. 2015;8(2):182-88.

Dal D, Çelıker V, Özer E, Başgül E, Salman MA, Aypar Ü. Induced hypotension for tympanoplasty: a comparison of desflurane, isoflurane and sevoflurane. Euro J Anaesthesiol. 2004;21(11):902-6.

Puthenveettil N, Rajan S, Kumar L, Nair SG. A comparison of effects of oral premedication with clonidine and metoprolol on intraoperative haemodynamics and surgical conditions during functional endoscopic sinus surgery. Anaesthesia Essays Res. 2013;7(3):371-5.

Guven DG, Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery. Anna Otol Rhinol Laryngol. 2011;120(9):586-92.

Shams T, El Bahnasawe NS, Abu-Samra M, El-Masry R. Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol. Saudi J Anaesthesia. 2013;7(2):175-80.

Degoute CS. Controlled hypotension drugs. 2007;67(7):1053-76.

Rodrigo C. Induced hypotension during anaesthesia with special reference to orthognathic surgery. Anaesthesia Progress. 1995;42(2):41.

Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice-a review. J Clin Diagnostic Res. 2014;8(10):GE01.

Guney A, Kaya FN, Yavascaoglu B, Gurbet A, Selmi NH, Kaya S et al. Comparison of esmolol to nitroglycerine in controlling hypotension during nasal surgery. Eur J Med. 2012;44(2):99-105.

Srivastava U, Dupargude AB, Kumar D, Joshi K, Gupta A. Controlled hypotension for functional endoscopic sinus surgery: Comparison of esmolol and nitroglycerine. Ind J Otolaryngol Head Neck Surg. 2013;65(2):440-4.

Vineela CH, Ganapathi P, Shankara Narayana P. Effect of controlled hypotension with dexmedetomidine versus nitroglycerine on intraoperative blood loss during FESS. J Dent Med Sci. 2015;14(4):42-5.

Al-Saidie EF, Ismail HM. Controlled hypotension for functional endoscopic sinus surgery: Comparison of esmolol and nitroglycerine. World J Pharmacy Pharmaceu Sci. 2016;12(5):286-93.

Baker AR, Baker AB. Anaesthesia for endoscopic sinus surgery. Acta Anaesthesiologica Scandinavica. 2010;54(7):795-803.

Boezaart AP, Van der Merwe J, Coetzee A. Comparison of sodium nitroprusside, and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesthesia. 1995;42(5):373-6.