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Updated: Feb 4, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Comparative Study between Magnesium Sulfate and Lidocaine for Controlled Hypotension during Functional Endoscopic
1Department of Anesthesiology, Faculty of Medicine, Fayoum University, Faiyum, Egypt.
Background:
Intraoperative bleeding impairs surgical field visibility during functional endoscopic sinus surgery (FESS); several methods have been used to decrease blood loss and improve surgical field, one of them is usage of hypotensive anesthetic agents.
Aim:
We intended to compare magnesium sulfate with lidocaine, regarding their efficiency in inducing controlled hypotension and providing a better surgical field exposure during FESS and the influence of their usage on extubation time.
Settings And Design:
This study design was a prospective randomized controlled double-blinded clinical study.
Patients And Methods:
Eighty adult patients with patients' physical status ASA Classes I and II, aged 20-50 years scheduled for FESS were randomly divided into two study groups; each group contains 40 patients: Group L received lidocaine 2 mg/kg/h with maximum of 200 mg/h starting at induction of anesthesia and continuing until the end of surgery and Group M received an iv bolus of magnesium sulfate 50mg/kg in a total of 100ml saline over 10 min followed by infusion of 15mg/kg/h until the end of surgery; patients were observed for the quality of the surgical field, blood loss, and extubation time.
Statistical Analysis Used:
Student's t-test or Mann-Whitney's U, Chi-square, or Fisher's exact tests were used.
Results:
Group L showed a significant decrease in blood loss (P = 0.01), better surgical field clarity (P = 0.002), and shorter extubation time (P = 0.001) than Group M, but there was no statistically significant difference between the two study groups as regards hemodynamics.
Conclusion:
We concluded that both magnesium sulfate and lidocaine successfully induced controlled hypotension in patients undergoing FEES, but lidocaine provided better surgical field clarity and shorter extubation time.
Insights
Lidocaine provided better surgical field clarity and shorter extubation times during functional endoscopic sinus surgery (FESS) compared to magnesium sulfate. Both anesthetics effectively induced controlled hypotension, but lidocaine offered superior outcomes for FESS procedures.
Area of Science:
- Anesthesiology
- Otolaryngology
- Surgical Oncology
Background:
- Intraoperative bleeding during functional endoscopic sinus surgery (FESS) compromises surgical field visibility.
- Controlled hypotension via anesthetic agents is a strategy to mitigate bleeding and enhance surgical exposure.
- Magnesium sulfate and lidocaine are explored for their hypotensive effects in FESS.
Purpose of the Study:
- To compare the efficacy of magnesium sulfate versus lidocaine in achieving controlled hypotension during FESS.
- To evaluate the impact of these agents on surgical field clarity and blood loss.
- To assess the influence on patient extubation time.
Main Methods:
- Prospective, randomized, double-blind clinical trial involving 80 adult patients (ASA Classes I-II, aged 20-50) undergoing FESS.
- Patients were randomized into two groups: one receiving lidocaine infusion, the other magnesium sulfate (bolus followed by infusion).
- Outcomes measured included surgical field quality, blood loss, extubation time, and hemodynamic parameters.
Main Results:
- Lidocaine group demonstrated significantly reduced blood loss (P=0.01) and superior surgical field clarity (P=0.002).
- Patients receiving lidocaine experienced significantly shorter extubation times (P=0.001).
- No significant hemodynamic differences were observed between the lidocaine and magnesium sulfate groups.
Conclusions:
- Both magnesium sulfate and lidocaine are effective in inducing controlled hypotension for FESS.
- Lidocaine offers advantages over magnesium sulfate, providing better surgical field exposure and faster extubation.
- Lidocaine is a favorable choice for optimizing surgical conditions and patient recovery in FESS.
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