الفهرس 
introductionOnly 14 pages are availabe for public view
 |  | from | 118 |  |  |
| | | from | 118 | | |
Abstract
the aim of this study was to compare the efficacy of esmolol, Sodium nitroprusside (SNP) and Magnesium sulphate (MgSO4) for inducing controlled hypotension during Endoscopic Sinus Surgery (ESS).
Sixty patients of either sex, aging 20-50 years, ASA I or II subjected to ESS were included in this study. Patients receiving cardiovascular active drugs, patients with history suggestive of cardiac or neurological diseases were excluded. Patients with respiratory, renal, hepatic disease or hypertensive were excluded as well.
All patients signed informed consent and the study was approved by the Departmental Ethics and Research Committee. The Patients were randomly divided into 3 groups (20 patients each):
Group I:
Patients received Esmolol as IV bolus application of 500 ug / kg, followed by continuous infusion at a rate of 100-300 ug / kg / min.
Group II:
Patients received SNP as starting rate of IV infusion of 1 ug / kg/min, then, continuous infusion rate of 1-10 ug /kg/min.
Group III:
Patients received MgSO4; 40 mg / kg administrated as a slow IV bolus over a 10 min period after the induction of anesthesia, then, 15 mg / kg /h by continuous i.v infusion during the operation.
Recorded data included Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP), and heart rate (HR), blood loss, operative time and average category scale (ACS) for evaluation of the quality of the operative field.
This study displayed statistically significant differences between the three drugs. The SBP, DBP and MAP were significantly lower in esmolol group compared to SNP group. Also, the SBP, DBP and MAP were lower in esmolol group compared to MgSO4 group, but with no significant difference, meanwhile the HR in SNP group was associated with statstically significant increase of HR compared to esmolol and MgSO4 groups and the intraoperative values of HR in esmolol group were lower than in MgSO4 group meanwhile at the end of surgery and the postoperative values of HR in MgSO4 group were lower than in esmolol group but with no significant difference.
There was a statistically significant decrease of the operative time and blood loss and there was an improvement of the quality of the operative field in the esmolol group compared to both SNP and MgSO4 groups.
This study also revealed that the use of esmolol or MgSO4 was associated with a better quality of the operative field and decreased operative time and blood loss than the use of SNP. Esmolol was superior to MgSO4 in its ability to decrease the the SBP, DBP and MAP, its abiliy to decrease the HR intraoperatively and to increase the HR postoperatively after stoppage of the drug infusion and in improving the quality of the operative field, decreasing the blood loss and decreasing the operative time.