الفهرس 
Controlled Hypotension
Medications Used Both as Primary Agents and AdjunctsOnly 14 pages are availabe for public view
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Abstract
Functional endoscopic sinus surgery (FESS) is becoming a
widely performed operation. Its introduction associated with enhanced
illumination and visualization has dramatically improved surgical
dissection. However major complications have been reported for
FESS under general anesthesia resulting from impaired visibility due
to excessive bleeding
Controlled hypotension is a technique used to limit
intraoperative blood loss to provide the best possible field for surgery.
Hypotensive techniques are safe and effective in inducing controlled
hypotension in children. Benefits for controlled hypotension for FESS
include reduction in blood loss with improved quality of surgical
field. Various agents e.g., magnesium sulfate. Vasodilators (sodium
nitroprusside), nitroglycerine, high doses of potent inhaled
anesthetics, and beta adrenergic antagonist have been used to achieve
controlled hypotension. Some disadvantages have been reported
of these techniques including delayed recovery from inhaled
anesthetics, resistance to vasodilators, tachyphylaxis, and cyanide
toxicity for nitroprusside.
Esmolol is an ultrashort acting selective β1 adrenergic
antagonist that reduces heart rate and blood pressure. It has rapid
onset of action of bolus i.v. injection and infusion. Upon termination
of infusion gradual recovery of arterial blood pressure to the pre
infusion level occurred without development of rebound hypertension.
Dexmedetomidine (DEX) is a potent highly selective α2
adrenergic receptor agonist. It has sedative, analgesic and anesthetic