Naithani Udita, Verma Priya, Ahamed Riyaz K, Choudhary Santosh, Gakkhar Vandana, Deshpande Gayatri
Department of Anesthesiology, RNT Medical College, Udaipur, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2024 Oct-Dec;40(4):659-665. doi: 10.4103/joacp.joacp_234_23. Epub 2024 Aug 16.
Bloodless surgical field during functional endoscopic sinus surgery (FESS) is an essential part, and research continues to find simple and effective regime for it. This study was aimed to compare the efficacy of oral clonidine versus oral metoprolol as premedicants regarding surgical field condition and controlled hypotension in patients undergoing FESS.
Sixty-eight patients of American Society of Anesthesiologists (ASA) physical status (PS) I and II aged 18-60 years, of both genders, scheduled for FESS under general anesthesia were randomly allocated in two groups. Group C ( = 34) received oral clonidine 300 μg and group M ( = 34) received oral metoprolol 50 mg, 2 h before surgery. Controlled hypotension (mean arterial pressure [MAP] 65-75 mmHg) was achieved by titrating sevoflurane (1%-3%). Primary outcome measured was surgical field visualization by Average Category Scale (ACS 0-5), and the secondary outcomes measured were hemodynamic parameters, sevoflurane requirement, recovery, and side effects. Categorical, continuous, and ordinal data were compared using Chi-square test, -test, and Mann-Whitney test, respectively. < 0.05 was considered as statistically significant.
ACS was significantly less in group C compared to group M up to 60 min, ( < 0.05). Mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP were significantly less in group C compared to group M at all time intervals ( < 0.05) Intraoperative sevoflurane requirement (vol %) was significantly less in group C (1.21 ± 0.42) compared to group M (1.68 ± 0.53) ( = 0.000).
Premedication with oral clonidine was found to be superior to oral metoprolol as it provided significantly better surgical field condition during FESS with much efficient controlled hypotension and anesthetic-sparing effect. CONSORT: http://www.consort-statement.org/.
功能性鼻内镜鼻窦手术（FESS）期间术野无血是一个重要环节，目前仍在继续探索简单有效的方法。本研究旨在比较口服可乐定与口服美托洛尔作为术前用药对FESS患者术野情况及控制性低血压的效果。
68例年龄在18 - 60岁、美国麻醉医师协会（ASA）身体状况（PS）为Ⅰ级和Ⅱ级、拟行全身麻醉下FESS的患者，随机分为两组。C组（n = 34）在术前2小时口服可乐定300μg，M组（n = 34）在术前2小时口服美托洛尔50mg。通过滴定七氟醚（1% - 3%）实现控制性低血压（平均动脉压[MAP] 65 - 75mmHg）。主要观察指标是采用平均分类量表（ACS 0 - 5）评估的术野可视化情况，次要观察指标包括血流动力学参数、七氟醚需求量、恢复情况及副作用。分类数据、连续数据和有序数据分别采用卡方检验、t检验和曼 - 惠特尼检验进行比较。P < 0.05被认为具有统计学意义。
在60分钟内，C组的ACS显著低于M组（P < 0.05）。在所有时间点，C组的平均收缩压（SBP）、舒张压（DBP）和MAP均显著低于M组（P < 0.05）。C组术中七氟醚需求量（体积百分比）（1.21±0.42）显著低于M组（1.68±0.53）（P = 0.000）。
发现口服可乐定作为术前用药优于口服美托洛尔，因为它在FESS期间能提供明显更好的术野情况，控制性低血压效果更佳且具有麻醉节省效应。CONSORT：http://www.consort-statement.org/ 。
