Efficacy of Dexmedetomidine and Labetalol for Induced Hypotension in Endoscopic Sinus Surgeries: A Randomised Clinical Study

Abstract

Introduction: Functional Endoscopic Sinus Surgery (FESS) is one of the most commonly performed surgical procedures that requires minimal bleeding during the procedure. Dexmedetomidine, an alpha-agonist and labetalol, a betablocker, have been used to decrease intraoperative bleeding and provide optimal surgical conditions. Aim: To evaluate the efficacy of labetalol and dexmedetomidine on intraoperative blood loss and surgical conditions during FESS. Materials and Methods: The present randomised singleblinded clinical study was conducted in the Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal, India, from January 2020 to May 2021. Study was performed on 60 patients aged 18-60 years undergoing FESS. The patients were divided into two groups: Labetalol (L) or Dexmedetomidine (D). Heart rate and arterial blood pressure were measured after induction, during and at the end of the surgery. An assessment of bleeding was done by a blinded surgeon. Surgical field quality, surgeon satisfaction, emergence time, Aldrete score and any side effects were observed. Data were analysed using the Statistical Package of Social Sciences (SPSS) software version 17.0 for Windows and the unpaired student t-test. Results: In the total study population, the mean age in group D was 42.96±11.52 years and in group L was 47.33±10.97 years. In both groups, female patients were more prevalent than males (Group L: 53.3%; Group D: 60%). There was a significant decrease in heart rate in group D compared to group L during and after the operation. Mean Arterial Pressure (MAP) after induction (106.63±6.094 mmHg vs 114.80±6.272 mmHg), at extubation and after extubation for six hours was significantly higher in group L than in group D. The emergence time of group D was higher than that of the labetalol group. The surgical field quality and surgeon satisfaction were significantly higher in group D. Time to reach Aldrete score ≥9 (15.67±1.788 vs 11.23±1.654), time for first analgesic requirement and Ramsay sedation score were found to be higher in group D and were statistically significant. Conclusion: Both dexmedetomidine and labetalol can be used for controlled hypotension during FESS. Dexmedetomidine provides more haemodynamic stability and is ideal for creating a better surgical field during endoscopic surgeries.

Keywords

• extubation
• controlled hypotension
• functional endoscopic sinus surgery
• mean arterial pressure