[Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery].

Adult patients aged 18 to 65 years with ASA I-II status undergoing functional endoscopic sinus surgery were randomized 1:1 to dexmedetomidine or magnesium sulfate. For the dexmedetomidine group, 30 participants were randomized; for the magnesium sulfate group, 30 participants were randomized.

This randomized comparison evaluated two active IV regimens during functional endoscopic sinus surgery. The dexmedetomidine group received a loading dose of 1 g.kg -1 in 100 mL saline 10 minutes before surgery, followed by an infusion of 0.5-1 g.kg -1 .h -1 during surgery; the magnesium sulfate group received a loading dose of 40 mg.kg -1 in 100 mL saline 10 minutes before induction, followed by 10-15 mg.kg -1 .h -1 intraoperatively.

Dexmedetomidine produced better controlled hypotension and a clearer surgical field than magnesium sulfate, with higher surgeon satisfaction. Blood loss scores favored dexmedetomidine, with more patients in the lowest bleeding categories and fewer in higher bleeding categories (p=0.002), and surgeon satisfaction was greater (p=0.001). Recovery to Aldrete score >= 9 was faster with dexmedetomidine (11.8 ± 2.5 min vs 14.8 ± 3.0 min; p=0.001). Dexmedetomidine also reduced the need for nitroglycerin (6.6% vs 33.3%; p=0.02), while anesthesia time, surgery time, extubation time, opening eyes, bradycardia, hypotension, vomiting, and tremor were not significantly different.

The trial was small, with only 30 participants per active arm, limiting precision and generalizability. It was a short perioperative study with no longer-term outcomes, and the study location/institution were not specified. Some outcome reporting was limited, and several safety and recovery endpoints were not significantly different.