Esmolol and Dexmedetomidine for Controlled Hypotension in Middle Ear Surgeries – A Prospective, Open-Labeled, Single-Center Study

ABSTRACT

Backgroundand Aims: Controlled hypotension has been used to reduce bleeding, the need for blood transfusions and provide a satisfactory bloodless surgical field. Esmolol, a short-acting cardioselective beta-blocker and dexmedetomidine, a central ?-2 adrenergic agonist both cause controlled hypotension. The aim was to study the effect of dexmedetomidine and compare it to esmolol for controlled hypotension, surgical field, dose requirement of induction agent, requirement of inhalational agent, and muscle relaxant in middle ear surgeries. Method: This study is a prospective, open-labeled, and single-center study. 100 patients of American Society of Anesthesiologists physical Status I and IIscheduled for middle ear surgeries lasting for 2–3 hunder general anesthesiawere included. Patients were divided into two groups of 50 each by computer-generated random numbers.Group E (n=50) patients esmolol infusion and Group D patients received dexmedetomidine infusion. Results:The two groups were comparable in terms ofhemodynamic parameters and surgical field assessment. The thiopentone dose requirement was 494 ± 12.93 mginGroup E and 354.50 ± 17.26 mg in Group D (P-0.022). The mean isoflurane concentration used in GroupsE andD was 45.30 ± 5.85 mland 13.79 ± 4.51 ml, respectively (P-0.002).The requirement of vecuronium was 11.19 ± 0.71mg in Group E and 4.58 ± 0.46 mg in Group D (P-0.009). Conclusion: The drugs provide controlled hypotension, good surgical field and reduce pressor response equally. In addition, dexmedetomidine reduces the dose requirement of induction agent, inhalational agent, and skeletal muscle relaxant.