Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus...

The purpose of this study was to compare surgical conditions for functional endoscopic sinus surgery (FESS) under general anaesthesia during controlled induced hypotension, using either sodium nitroprusside (SNP) or esmolol. Twenty patients, assigned to receive either of the drugs as the primary hypotensive agent, were studied. The same surgeon, blinded to the hypotensive agent used and the haemodynamic variables, performed all the operations. The surgeon used a category scale (0-5) to assess surgical conditions--a value of 2-3 being ideal. Patients were positioned in 5 degrees reverse Trendelenburg position and the mean arterial blood pressure (MABP) was reduced in steps of 5 mmHg. The anaesthetist prompted category scale estimations by the surgeon following a change in any of the haemodynamic variables. Average category scale (ACS) values were compared between the two groups for four data groups, i.e., MABP > 65 mmHg (mild), 60-64 mmHg, 55-59 mmHg and 50-54 mmHg. Pre-treatment MABP was 79.8 +/- 10.4 mmHg in the SNP group and 76.1 +/- 6.8 mmHg in the esmolol group. At mild SNP-induced hypotension, surgical conditions were poor (ACS = 3.63 +/- 0.22; mean +/- SEM), while in the esmolol group, ideal surgical conditions (ACS = 2.94 +/- 0.34) were recorded at MABP > 65 mmHg. The combined effects of increased venous drainage due to the reverse Trendelenburg position, hypotension as well as capillary vasoconstriction due to unopposed alpha-adrenergic effect on the mucous membrane vasculature in the esmolol group (as opposed to vasodilatation in the SNP group) probably caused the superior surgical conditions.