Effect of dexmedetomidine on blood loss and quality of surgical field in functional endoscopic sinus surgery: A double blinded prospective controlled study

Background: Functional endoscopic sinus surgery (FESS) is a widely performed operation with one of its major drawbacks being impaired visibility due to excessive bleeding. Controlled hypotension during general anaesthesia for FESS has been shown to improve surgical dissection. This study was carried out with the aim of evaluating the effect of dexmedetomidine on surgical blood loss and quality of surgical field in FESS. Methodology: This prospective randomized double blinded controlled study was conducted on 100 patients posted for elective FESS. After obtaining institutional ethical clearance, patients between the ages 18 and 60 yrs belonging to ASA PS I and II, scheduled to undergo elective FESS surgery under general anaesthesia were included in the study. Fifty patients each were sorted into either the study group (Group I/D) receiving dexmedetomidine or control group (Group II/NS) receiving normal saline. The two groups were compared using student's t-test for age, weight, mean arterial pressure, heart rate, amount of blood loss, EtCO2 and SpO2.Chi square analysis and Fisher's exact test were used for analysis of gender, ASA physical status and surgeon's satisfaction after surgery. Statistical significance was determined at P < 0.05. Results: Both the groups; D and NS were comparable in terms of weight, age, sex and ASA physical status. Mean arterial pressure (MAP) and heart rate (HR) were compared between the two groups at every step of the procedure and dexmedetomidine was shown to produce a drop in both hemodynamic parameters producing stable vital parameters. The average intraoperative blood loss was found to be significantly higher in the control group. Surgeon's satisfaction with the operative experience was also found to be significantly better with the study group than in the control group. Conclusion: This study found that dexmedetomidine produces stable blood pressure and heart rate with minimal fluctuations from the baseline during FESS. This hemodynamic stability leads not only to a good patient outcome, but also increases surgeon satisfaction.