HEMODYNAMIC HARMONY - A COMPARATIVE STUDY OF THE EFFECTS OF DEXMEDETOMIDINE AND MAGNESIUM SULPHATE ON HEMODYNAMICS DURING FESS: A RANDOMIZED CONTROL STUDY

Abstract

Background: Functional Endoscopic Sinus Surgery (FESS) is often associated with significant hemodynamic fluctuations due to the stress response to airway manipulation and surgical stimuli. Adequate control of these fluctuations is essential to minimize perioperative complications and improve surgical conditions. Dexmedetomidine, an α2-adrenoceptor agonist, and magnesium sulphate, an N-methyl-D-aspartate (NMDA) receptor antagonist, have been studied individually for their potential to provide perioperative hemodynamic stability. However, head-to-head comparisons in patients undergoing FESS are limited.

Methods: In this randomized controlled study, 80 patients of FESS were enrolled and divided into two groups in equal numbers (Group D: dexmedetomidine and Group M: magnesium sulphate). The sample in both the groups consisted of 40 patients of 18–60 years age group, of both genders, of ASA physical status I or II. Intraoperative heart rate, demographic parameters at baseline, mean arterial pressure, and sedation levels were measured. Incidence of adverse events, rescue medication usage, and recovery times were also noted. Statistical differences were analyzed using Student's t-test or Chi-square test, and a p-value of < 0.05 was considered significant.

Results: Both dexmedetomidine and magnesium sulphate had significant attenuation of perioperative hemodynamic reactions versus usual care. Patients treated with dexmedetomidine had a more uniform decrease in HR and MAP throughout the intraoperative period. Magnesium sulphate was moderately effective at producing stable hemodynamics but was noted to have a slightly increased incidence of perioperative hypotension. Sedation scores and recovery times were equivalent between groups, though dexmedetomidine had a tendency to produce smoother emergence profiles.

Conclusion: Both magnesium sulphate and dexmedetomidine were effective at managing intraoperative hemodynamic variations in FESS. Dexmedetomidine offered a more consistent profile with fewer instances of hypotension. More research with larger patient groups is needed to validate the results and better determine the dosing strategy.