Kiran Kumar Suggala1 , B. Kishan Rao2 , M. H. Nagrale3
BACKGROUND Functional Endoscopic Sinus Surgery (FESS) is a procedure for surgical management for chronic sinusitis. To achieve this, Hypotensive anaesthesia is widely used. We wanted to evaluate the safety and efficacy of dexmedetomidine as a hypotensive agent in comparison with clonidine in FESS. METHODS This randomized, double blind, prospective controlled study was done in a tertiary care hospital in Telangana. Sixty ASA physical status I and II patients (20-50 years) undergoing FESS were randomly allocated to one of the two groups. Group C, patients received 3 μg/Kg of clonidine diluted in 10 ml 0.9% normal saline infused over 10 minutes before induction of anaesthesia intravenously, followed by continuous infusion of 0.4-0.8 μg/Kg/hr. In group D, patients received loading dose of 1 μg/Kg Dexmedetomidine diluted in 10 ml 0.9% normal saline infused over 10 minutes before induction of anaesthesia, followed by continuous infusion of 0.4-0.8 μg/Kg/hr. RESULTS Target MAP was easily achieved in both groups and in Dexmedetomidine it was still lower compared to clonidine group. The MAP was successfully reduced to the target value (55-65 mmHg) in both groups, but MAP at incision was comparable in both groups and after 15 minutes was significantly lower in Group D (60.67 ± 5.9) when compared with Group C (65.63 ± 6.9), with a p-value <0.005. No patient in any of the two groups required additional therapy to achieve target MAP. Significant reduction in intraâ??operative blood loss, better surgical site scoring (1 or 2), and good analgesia and sedation were seen in both groups. Hence both drugs can be used for achieving hypotension, but Dexmedetomidine was more effective, safe and required in low doses compared to clonidine. CONCLUSIONS Both dexmedetomidine and clonidine provide good hemodynamic stability and safe operative field visibility, decreased blood loss; but, dexmedetomidine provides an additional benefit of reducing the analgesic requirements and provides significant postoperative sedation compared to clonidine.
