Deliberate Controlled Hypotension in Functional Endoscopic Sinus Surgeries: A Comparative Study between Nitroglycerin and Esmolol

Background: Functional endoscopic sinus surgery (FESS) enjoys the privilege of being a minimally invasive intervention for nasal disorders. Intraoperative bleeding is the major problem in these endoscopic surgeries. Excessive bleeding impairs operative visibility, prolongs the duration of surgery and anesthesia, and increases the risk of complications. Controlled hypotension is a method wherein the arterial blood pressure is lowered in a deliberate but predictable manner to reduce the intraoperative bleeding and enhance the surgical field visibility. Aim: The aim of this study was to compare the mean change in heart rate (HR), systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), surgical bleeding, and duration of hypotensive anesthesia caused by nitroglycerin (NTG) or esmolol (ESM), when performing FESS. Materials and Methods: Sixty patients of American Society of Anesthesiologists I and II undergoing FESS under general anesthesia were divided into two groups– the NTG and the ESM group. Vitals were recorded at regular intervals. Hemorrhage was estimated by volumetric and gravimetric estimation. Visibility of the surgical field was rated by the surgeon Fromme et al, with 0 being the driest and 5 making surgery impossible. Results: Intraoperative HR, surgical bleeding, and duration were less in the ESM group. Visibility was much superior in this group too. Conclusions: Both drugs are safe and effective in providing optimal operating conditions, but ESM is superior because it provides superior surgical dryness at higher MAPs and reduces the surgical blood loss and duration more than NTG. Absence of reflex tachycardia was the added advantage of ESM over NTG.