الفهرس 
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Abstract
During endoscopic sinus surgery (ESS), bleeding from the mucosal surfaces can interfere with visualization of the anatomy and increase the risk of serious complications such as orbital or skull base injury with resultant cerebrospinal fluid leak. In addition, reduction of bleeding could result in greater ease and thoroughness of the sinus surgery owing to better visibility. There are multiple factors that contribute to blood loss during surgery, including, but not limited to, surgical and anesthesia technique. Historically, several ways have been used to minimize intraoperative bleeding.Hemostasis is critical for adequate anatomical visualization during endoscopic endonasal skull base surgery. Reduction of intraoperative bleeding should be considered during the treatment planning and continued throughout the perioperative period. Preoperative preparations include the optimization of comorbidities and cessation of drugs that may inhibit coagulation.Intraoperative considerations comprise anesthetic and surgical aspects. Controlled hypotension is the main anesthetic technique to reduce bleeding; however, there is controversy regarding its effectiveness; what the appropriate mean arterial pressure is and how to maintain it. Verapamil is a non-dihydropyridine calcium channel blocker which can potentiate analgesic action of local anesthetics, prolongs postoperative analgesia, and decreases analgesic consumption. Calcium has a fundamental role in pain signals formation and processing. The stimulation of NMDA receptor results in calcium entry into cells and potentiation of spinal cord and plays a role in pain processing. Hence, central sensitization can be prevented by voltage-gated calcium channel blockers and provide better sensory motor block characteristics.Bisoprolol is a cardioselective β1-adrenergic blocking agent used to treat high blood pressure. and can be useful in patients with chronic obstructive pulmonary disease (COPD) due to its receptor selectivity Bisoprolol decreases heart rate (chronotropy), decreases contractility (inotropy), and reduces blood pressure . the mechanism of action of bisoprolol has not been fully elucidated in hypertension, it is thought that therapeutic effects are achieved through the antagonism of β-1adrenoceptors to result in lower cardiac output. Bisoprolol is a competitive, cardioselective β1-adrenergic antagonist. Bisoprolol is also thought to reduce the output of renin in the kidneys, which normally increases blood pressure. Additionally, some central nervous system effects of bisoprolol may include diminishing sympathetic nervous system output from the brain, decreasing blood pressure and heart rateThe aim of the study was to assess the effect of addition of Bisoprolol and verapamil to general aneasthesia aimed reduction in heart rate and blood loss during endoscopic sinus surgery.This comparative clinical study was conducted on 135 patients of ASA Grade I & II, aged between 18 - 60 years, undergoing FESS under general anesthesia.