الفهرس 
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Abstract
Summary
Rhino-sinusitis, an important cause of significant discomfort and morbidity is commonly treated with FESS nowadays. However, there can be serious complications associated with this type of operations during peri-operative period as orbital cellulitis, optic nerve injuries, meningitis, etc. whose incidence can increase with excessive bleeding during operation. Hence, it is mandatory to keep the surgical field as free of blood as possible to improve visibility of anatomical landmarks and structures. This can be provided with the use of topical vasoconstrictors, with local anesthesia or use of hypotensive general anaesthesia.
Opioid analgesics suppress stress response to intubation and surgery and , hence prevent increase in HR and MABP.
Washburn et al (134)reported that using opioids to achieve hypotensive anesthesia led to decreased amount of bleeding and diminished the risk of blood transfusion during orthognathic surgery, a type of operations that also employed using hypotensive general anaethesia.
In this randomized study we tried to determine the efficacy of using intravenous morphine verus nalbuphine on intra-operative MABP, HR and NG dose used to achieve hypotensive anaesthesia in FESS.We enrolled 68 patients ASA Ι aged 18-50 years old’ divided into two equal groups each included 34 pastients, group Ι received morphine 0.1 mg/kg 30 min before induction, group Π received nalbuphine 0.1 mg/kg 30 min before induction. We compared both groups regarding MABP, HR, bleeding score, NG doses, surgeon satisfaction score, recovery time and sedation score.
We concluded that morphine 0.1 mg/kg I.V 30 min before induction statistically significant reduced MABP after 5, 15, 30 and 45 min post intubation and also reduced NG doses needed to achieve hypotensive anaesthesia .