Dexmedetomidine Added to Hyperventilation Improves Surgical Field Visibility Without Compromising Cerebral...

Optimal surgical field visibility is essential during endoscopic sinus surgery (ESS), yet strategies that reduce bleeding may raise concern about impaired cerebral oxygenation. We evaluated whether adding dexmedetomidine to hyperventilation improves surgical field visibility during ESS without compromising cerebral oxygenation.

In this double-blinded randomized controlled trial, 74 patients with chronic rhinosinusitis undergoing ESS were randomly assigned to receive dexmedetomidine plus hyperventilation or hyperventilation alone. The primary endpoint was the Boezaart surgical field score assessed 30 min after the start of surgery. Secondary endpoints were intraoperative cerebral oxygen saturation (ScO₂), bleeding rate, hemodynamic variables, anesthetic consumption, and postoperative recovery outcomes.

Compared with hyperventilation alone, dexmedetomidine plus hyperventilation improved surgical field visibility, with a lower Boezaart score at 30 min after surgery onset (2.0 (1.0-2.0) vs. 3.0 (2.0-3.0), p = 0.003). Longitudinal analysis further demonstrated that dexmedetomidine plus hyperventilation was associated with lower odds of poorer surgical field scores over time (OR = 0.180, 95% CI, 0.062-0.524; p = 0.002). The bleeding rate was lower with dexmedetomidine plus hyperventilation, whereas intraoperative ScO₂ was comparable between groups and no cerebral desaturation events occurred.

In patients undergoing ESS, adding dexmedetomidine to hyperventilation improved surgical field visibility without compromising intraoperative cerebral oxygenation. This combined strategy may help optimize operative conditions in ESS.