Assessment of Perioperative Hemodynamic Responses and Recovery Characteristics Following the Use of Dexmedetomidine Versus Esmolol for Controlled Hypotension During Functional Endoscopic Sinus Surgery

Abstract

Background: Functional endoscopic sinus surgery (FESS) is associated with intraoperative bleeding that may impair surgical visualisation and increase operative difficulty. Controlled hypotension is commonly used to reduce blood loss and improve surgical conditions. Dexmedetomidine and esmolol are frequently used agents for achieving controlled hypotension; however, their effects on perioperative hemodynamic stability and recovery characteristics differ. Aim: To compare perioperative hemodynamic responses, surgical field quality, blood loss, recovery profile, and postoperative complications following the use of dexmedetomidine versus esmolol for controlled hypotension during FESS. Materials and Methods: This prospective randomized comparative study was conducted in the Department of Anaesthesiology at C.S.I. Redfern Memorial Hospital, Hassan, Karnataka, from January 2023 to December 2026. A total of 100 patients undergoing elective FESS under general anaesthesia were randomly allocated into two groups of 50 patients each. Group D received dexmedetomidine infusion, while Group E received esmolol infusion for controlled hypotension. Perioperative heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation, surgical field quality, intraoperative blood loss, recovery parameters, and postoperative complications were assessed. Results: Both groups were comparable regarding demographic characteristics, baseline laboratory investigations, and preoperative hemodynamic parameters. Dexmedetomidine provided better attenuation of heart rate response during intubation, controlled hypotension, and extubation compared with esmolol (p<0.05). Mean arterial pressure was more consistently maintained in the dexmedetomidine group with fewer perioperative fluctuations. The dexmedetomidine group demonstrated better surgical field visibility with a higher proportion of excellent Boezaart scores and significantly lower intraoperative blood loss compared with the esmolol group (94.6 ± 25.8 ml vs 120.8 ± 31.4 ml, p<0.05). Recovery parameters including time to eye opening, extubation time, response to verbal commands, and PACU stay were significantly shorter in the dexmedetomidine group. Both groups showed comparable safety profiles without major adverse events. Conclusion: Dexmedetomidine provides superior perioperative hemodynamic stability, improved surgical field quality, reduced intraoperative blood loss, and faster postoperative recovery compared with esmolol when used for controlled hypotension during functional endoscopic sinus surgery. Dexmedetomidine may therefore be considered an effective agent for achieving controlled hypotension with favourable recovery characteristics.

keywords: Dexmedetomidine; Esmolol; Functional Endoscopic Sinus Surgery (FESS); Controlled Hypotension; Hemodynamic Stability; Mean Arterial Pressure; Intraoperative Blood Loss; Recovery Profile; Surgical Field Quality; General Anaesthesia.