Abstract:
ABSTRACT
Background:
Functional Endoscopic Sinus Surgery (FESS) demands a bloodless operative
field and stable hemodynamics to ensure surgical precision and minimize
complications. Controlled hypotension is a vital anesthetic technique in
achieving optimal visibility. Dexmedetomidine, a selective α2-adrenergic
agonist, is commonly used due to its sedative and sympatholytic effects.
Fentanyl, a potent opioid analgesic, helps blunt sympathetic responses but lacks
sufficient hypotensive effect when used alone. The present study evaluates
whether the combination of dexmedetomidine and fentanyl offers superior
outcomes over dexmedetomidine alone in FESS.
Aim:
To compare the efficacy and safety of infusion of inj. dexmedetomidine with inj.
fentanyl versus infusion of inj. dexmedetomidine alone in providing hypotensive
anesthesia in patients undergoing FESS.
Methods:
A randomized, controlled, prospective study was conducted on 106 patients
(ASA Grade I/II) aged 18–60 years scheduled for elective FESS. Patients were
divided into two groups: Group D received 0.5μg/kg/hr dexmedetomidine
infusion; Group DF received 0.5 μg/kg/hr dexmedetomidine plus 0.5μg/kg/hr
fentanyl infusion. Hemodynamic parameters (HR, SBP, DBP, MAP) were
monitored at various intraoperative intervals. Surgical field quality was assessed
using Boezaart’s scale, and surgeon satisfaction and adverse events were
documented.
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Results:
Group DF showed significantly better hemodynamic control with lower mean HR
(68.7 ± 5.1 bpm vs. 72.1 ± 5.9 bpm, p = 0.001) and MAP (62.9 ± 3.1 mmHg vs.
81.2 ± 3.1 mmHg, p < 0.001). The Boezaart score was significantly better in
Group DF (2.04 ± 0.6 vs. 2.42 ± 0.8, p = 0.006). Surgeon satisfaction rated
‘excellent’ was higher in Group DF (56.6% vs. 45.3%). Adverse events such as
bradycardia (7.5% vs. 30.1%) and hypotension (5.7% vs. 22.6%) were fewer in
Group DF. Only 5.6% in Group DF required postoperative analgesia versus 32%
in Group D (p < 0.05).
Conclusion:
The combination of dexmedetomidine and fentanyl infusion provides superior
hemodynamic stability, improved surgical field visibility, fewer adverse events,
and reduced postoperative analgesic requirement compared to dexmedetomidine
alone. This combination is safe, effective, and offers a better anesthetic choice for
controlled hypotension in FESS.
