Dexmedetomidine versus labetalol for induced hypotension during functional endoscopic sinus surgery: a randomized, double-blind study
"Dexmedetomidine provided better hemodynamic stability and operative field visibility than Labetalol during FESS."
Background & Objective:
"Functional endoscopic sinus surgery (FESS) is a surgical procedure for treating sinus diseases. Bleeding is a common concern during FESS, so maintaining hemodynamic stability and ensuring quality surgical field visibility is crucial for achieving the best outcomes. The present study compared the time taken to achieve target mean arterial pressure (MAP) when using dexmedetomidine or labetalol during FESS and assessed the quality of the surgical field to establish the better choice of the two."
Methodology:
"The study was conducted as a prospective, randomized, double-blinded clinical study. Sixty patients classified as American Society of Anesthesiologists grade I or II, undergoing FESS under general anesthesia, were divided into two groups, each with 30 patients. Group D patients received dexmedetomidine and Group L received labetalol. The study aimed to maintain the mean arterial pressure (MAP) between 60-70 mmHg. The operative field visibility was assessed using the Fromme and Boezaart scoring system. Emergence time and postoperative first analgesic request time were also recorded."
Results:
"The time taken to achieve target MAP (60-70 mmHg) was less in Group D (15.1 ± 0.2 min) than in Group L (18.2 ± 0.5 min), and it was statistically significant (P < 0.05). Although insignificant, lower MAP were observed in the Group D than Group L. A significantly lower heart rate was observed at defined intervals in Group D than in Group L. The visibility of the surgical field in both groups has comparable results. The first analgesic request time was considerably longer in Group D (52.2 ± 1.9) compared to Group L (10.2 ± 2.1) (P < 0.05)."
Conclusion:
Dexmedetomidine provided better hemodynamic stability and operative field visibility than Labetalol during FESS.
Excerpts:
In the functional endoscopic sinus surgery (FESS), capillary oozing is a significant contributing factor in the operative field bleeding, which can be reduced by induced hypotension and topical vasoconstriction.
In hypotensive anesthesia, the goal is to reduce the mean arterial pressure (MAP) by approximately 25-30% from the patient's baseline level. However, to ensure that the MAP does not fall below 60 mmHg is crucial to maintaining sufficient perfusion to vital organs.3
An ideal hypotensive agent should be readily available and have a fast onset, rapid elimination, with nontoxic metabolites, and predictable effects
We conclude that dexmedetomidine and labetalol are safe agents for controlled hypotension. Both are effective in providing a more acceptable surgical field with minimal blood loss during FESS. However, compared to labetalol,
dexmedetomidine offers the advantage of an inherent analgesic, sedative, and anesthetic sparing effect and achieves target mean arterial pressure earlier. However, it may prolong the sedation and the recovery during the postoperative period.
Citation
Gupta S, Yadav I, Saxena A, Bagla RK, Nazir N. Dexmedetomidine versus labetalol for induced hypotension during functional endoscopic sinus surgery: a randomized, double-blind study. Anaesth. pain intensive care 2024;28(4):652−657; DOI: 10.35975/apic.v28i4.2507
