A Comparison between Propofol, Dexmeditomedine and Nitroglycerin as Hypotensive Agents and their Effect on Blood Loss in Functional Endoscopic Sinus Surgery (FESS)

Abstract

Background: Functional endoscopic sinus surgery (FESS) has been proposed as selected treatment used in patients with chronic sinusitis that have not responded to medical therapy. Due to the nature location of endoscopic sinus surgery; even a small amount of bleeding can reduce the operative visibility. The aim of the work was to compare between propofol, Dexmeditomedin and nitroglycerin as regards their effects as hypotensive agents and their effects on blood loss in FESS Patients and methods: Sixty adult patients of ASA physical status I and II, admitted to Ain Shams University hospital, scheduled for FESS and were randomly assigned into three groups, (D group) for dexmedetomidine (n=20), (P group) for propofol (n=20) and (N group) for nitroglycerine (n=20). In Group (D) patients received dexmeditomedin loading dose of 1 mcg/kg over 10 (on 100ml normal saline) before induction followed by a maintenance infusion of 0.5mcg/kg/hr. In Group (P) patients received propofol infusion 8mg/Kg/hr IV. In group (N): patients received nitroglycerin infusion 2μg/kg/min. MAP and HR were measured continuously and recorded every 15 minutes, bleeding score for assessment of intraoperative surgical field and duration of surgery was measured. Results: Targeted mean arterial pressure (MAP) of (55-65 mmHg) and improved surgical field quality were achieved in group D and group P. Also dexmeditomedine was faster in achieving target blood pressure than propofol heart rate (HR) was significantly lower in the D group. Duration of surgery was shorter in group D and group P. Conclusion: Dexmedetomidine and propofol are more effective in achieving controlled hypotention than nitroglycerine. Both drugs were associated with less bleeding and shorter duration of surgery in patients undergoing FESS. Dexmeditomedine was more effective in controlling heart rate than propofol and nitroglycerine. Also dexmeditomedine was faster in achieving target blood pressure than propofol.