Controlled Hypotension During Functional Endoscopic Sinus Surgery (FESS) - A Comparative Evaluation Between Esmolol and Nitroglycerine

Kotaru Gowtham, Mittapally Shankar, Bhagothula Sowjanya


Background: Intraoperative bleeding is a frequent complication in functional endoscopic sinus surgery (FESS). Controlled hypotension is a useful technique for enhancing the surgical field and reducing operative blood loss. Nitrovasodilators and beta receptor antagonists are effective options for regulated hypotensive anaesthesia during FESS. We assessed the efficacy of esmolol and nitroglycerine for controlled hypotension in subjects undergoing FESS.

Methods: A source of 64 participants undergoing elective FESS, were randomly allocated to group N (n=32), which got an intravenous Nitroglycerin infusion at 5–10 µg/kg/min, and group E (n=32), which received an initial bolus of 500 mcg/kg of intravenous esmolol over 30 seconds. Hemodynamic parameters were measured and the visibility of the surgical field was assessed using the average category scale (ACS).

Result: In groups N and E, the mean surgical duration was 113.5 minutes and 102.34 minutes, respectively, and the mean operative blood loss was 188.5 ml and 173.7 ml. The esmolol group experienced a rapid decline in heart rate, and there was a statistically significant difference in mean SBP, DBP, and MAP across the study groups. At the 10-min, the majority of cases displayed scores of 3 in group E and 4 in group N. In the esmolol group, there was a significant difference between the hypotensive phase and the hemodynamic measures (p<0.05).

Conclusion: Nitroglycerine and esmolol were effective in controlling hypotension. However, esmolol was superior in controlling the operative bleeding, surgical duration, enhanced surgical field visibility, and absence of reflex tachycardia compared to nitroglycerine


Esmolol; nitroglycerine; controlled hypotension; average category scale; efficacy

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Suhitharan T, Sangeetha S, Kothandan H, Esther DY, Ho VK. Anesthetic techniques and haemodynamic control for endoscopic sinus surgery: A retrospective analysis and review of literature. Egypt J Anaesth. 2017; 33:9‑14.

Das A, Chhaule S, Bhattacharya S, et al. Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study. Saudi J Anaesth. 2016; 10:276-82. DOI: 10.4103/1658-354X.174919

Ahn HJ, Chung SK, Dhong HJ, et al. Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery. Br J Anaesth. 2008 Jan;100(1):50-4. doi: 10.1093/bja/aem304. Epub 2007 Nov 3.

Cardesin A, Pontes C, Rosell R, et al. A randomised double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia. Rhinology. 2015;53(2):107-15. doi: 10.4193/Rhino14.185.

Sajedi P, Rahimian A, Khalili G. Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy. J Res Pharm Pract. 2016 Oct-Dec;5(4):264-271. doi: 10.4103/2279-042X.192463.

Moreno DH, Cacione DG, Baptista-Silva JC. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev. 2018 Jun 13;6(6):CD011664. doi: 10.1002/14651858.CD011664.pub3.

Ankichetty SP, Ponniah M, Cherian V, et al. Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):328-32. doi: 10.4103/0970-9185.83675.

Degoute CS. Controlled hypotension: a guide to drug choice. Drugs. 2007;67(7):1053-76. doi: 10.2165/00003495-200767070-00007.

Shams T, El Bahnasawe NS, Abu-Samra M, El-Masry R. Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol. Saudi J Anaesth. 2013 Apr;7(2):175-80. doi: 10.4103/1658-354X.114073.

Guney A, Kaya FN, Yavascaoglu B, et al. Comparison of esmolol to nitroglycerine in controlling hypotension during nasal surgery. Eurasian J Med. 2012;44(2):99-105. doi: 10.5152/eajm.2012.23.

Birendra KR, Dharmendra KY, Deepti PA. Randomized comparative study of nitroglycerin and esmolol for controlled hypotension in functional endoscopic sinus surgeries. International journal of scientific research. 2020;9(3):33-35.

Blau WS, Kafer ER, Anderson JA. Esmolol is more effective than sodium nitroprusside in reducing blood loss during orthognathic surgery. Anaesth Anal. 1992; 75: 172-178.

Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995;42(5 Pt 1):373-6. doi: 10.1007/BF03015479.

Srivastava U, Dupargude AB, Kumar D, Joshi K, Gupta A. Controlled hypotension for functional endoscopic sinus surgery: comparison of esmolol and nitroglycerine. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 2):440-4. doi: 10.1007/s12070-013-0655-5. Epub 2013 Apr 27.

Bajwa SJ, Kaur J, Kulshrestha A, Haldar R, Sethi R, Singh A. Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation. J Anaesthesiol Clin Pharmacol. 2016 Apr-Jun;32(2):192-7. doi: 10.4103/0970-9185.173325.

Raghavendra TR, Yoganarasimha N, Shivakumar A, Radha MK. Deliberate controlled hypotension in functional endoscopic sinus surgeries: A comparative study between nitroglycerin and esmolol. Karnataka Anaesth J. 2016; 2:54-8. DOI: 10.4103/2394-6954.194820.

Rahul S, Kusugal RR. Comparative study of Nitroglycerin and Esmolol for controlled hypotension in FESS. International Journal of Current Research. 2018;10(01), 64174-64179.

Kakati R, Borah P, Bhattacharyya RK, Deori AK. Controlled hypotension in functional endoscopic sinus surgery: a comparison between esmolol and dexmedetomidine - a randomized prospective study. International Journal of Contemporary Medical Research. 2018;5(2):B30-B33



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