Efficacy and safety of use of dexmedetomidine with fentanyl vs dexmedetomidine for hypotensive anaesthesia in patients undergoing functional endoscopic sinus surgery.

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. Docusign Envelope ID: EE1BE69F-CB50-4588-8F03-B511E932D8A0

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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.