Dr. Birendra Kumar Raw, Dr. Dharmendra Kumar Yadav, Dr. Deepti Pal


Background : Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive procedure for disease of Nose and Paranasal  sinuses like chronic sinusits and polyps rhinosinusitis.  Intraoperative bleeding causes poor visibility of surgical field is a major concern during FESS and this may results in many complication . Controlled hypotension is a technique where in arterial blood pressure  is lowered in deliberate but controlled manner to minimize blood loss and enhance operative field visibility.


Aim: To compare the hypotensive efficacies of intravenous Esmolol and intravenous Nitroglycerin in Functional Endoscopic Sinus Surgeries under general anaesthesia.In term of changes in heart rate ,systolic blood pressure, diastolic blood pressure ,mean arterial pressure, duration of surgery  and operative field visibility assessment by surgeon by using Fromme scale.


Methods: This study was conducted on total 60  patients, divided into two groups.

Group Nitroglycerin (NTG) 30 patients , Group Esmolol (ESM) 30 patients.Patients between ASA grade I&II, age 18-60 years undergoing Functional Endoscopic Sinus Surgery  under GA , Either injection Esmolol 100-300 mcg/kg/min and NTG groups 0.5 -10 mcg/kg/min  through infusion pumps. All patient s were premedicated with Ondansetron (0.1mg/kg )IV,Midazolam(0.02mg/kg)IV,Glycopyrrolate(0.01mg/kg) and  Fentanyl (2µg/kg) and then induced with Propofol 2mg/kg IV. Laryngoscopy and intubation was facilitated by  Succinylcholine 2 mg/kg IV. Anaesthesia was maintained with Isoflurane vapour in balanced Nitrous oxide and Oxygen mixture and  Vecuronium 1mg IV every 10-20 min for musle relaxation. Heart rate, Systolic Blood Pressure , Diastolic and Mean Arterial Blood pressure were assessed at 5min,10min,15min and so on upto 60 min.



Result: Introperative Heart rate was less in Esmolol(ESM) as compared to Nitroglycerine(NTG) group.  Both drugs produced desired hypotension but ideal operating conditions were achieved at a  higher MAP of 80.74±2.6 mm Hg in ESM groups ,while same operating conditions, were achieved at lower MAP of 73.49±2.07 mm Hg in NTG group.


Conclusion: Both drugs  are  safe  and effective  in providing optimal operating conditions but Esmolol is superior agent to NTG  for controlled hypotension in FESS  under general anaesthesia as it minimizes surgical blood loss, enhance operative visibility and reduces duration of surgery with minimal reduction in MAP . Absence  of reflex tachycardia was added advantages of Esmolol over Nitroglycerin.


Functional endoscopic sinus surgery,Controlled hypotension ,Nitroglycerin, Esmolol, Fromme scale

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Cincikas D, Ivaskevicius J, Martinkenas JL, Balseris S. A role of anaesthesiologist in reducing surgical bleeding in endoscopic sinus surgery. Medicina 2010; 46: 730-734.

Kamal HM, Abd El-Rahman AS. Clevidipine for deliberate hypotension in functional endoscopic sinus surgery (FESS). Egyptian Journal of Cardiothoracic Anesthesia 2008; 2: 158-164.

Cincikas D, Ivaskevicius J. Application of controlled arterial hypotension in endoscopic rhinosurgery. Medicina 2003; 39: 852-859.

Testa LD, Tobias JD. Pharmacological drugs for controlled hypotension. Journal of Clinical Anesthesia 1995; 7: 326-337.

Blau WS, Kafer ER, Anderson JA. Esmolol is more effective than sodium nitroprusside in reducing blood loss during orthognathic surgery. Anaesth Anal 1992; 75: 172-178.

Simpson P. Perioperative blood loss and its reduction: The role of the anaesthetist. British Journal of Anaesthesia 1992; 69: 498-507.

Fromme GA, MacKenzie RA, Gould AB, Lund BA, Offord KP. Controlled hypotension for orthognathic surgery.Anaesth Analg 1986; 65: 683-6.

.Srivastava U,Joshi K ,Gupta A et al 2013 : controlled hypotension for Functional Endoscopic Surgery :comparison of Esmolol and Nitroglycerin. Indian Journal of otolaryngology ,Head and neck surgery ,65(2): S440-S444.

Guney A,Kaya F N,et al 2012 : comparison of Esmolol to Nitroglycerin in controlling hypotension during nasal surgery.The Eurasian Journal of medicine,44 ;99-105.

Dongre H, Sharma V et al 2012 , The efficacy of Esmolol and Nitroglycerin in creating dry operative field by producing controlled hypotension in spinal surgeries : IOSR Journal of Pharmacy ,2(4):26-33.

Shams T, Abu-Samra et al 2013- Induced hypotesion for Functional Endoscopic Sinus Surgery : A comparative study of Dexmedetomidine versus Esmolol. Sandi Journal of Anaestheia ; 7(2) :175-80.


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