Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgeries: A Systematic Review

Abstract

This systematic review comprehensively analyzes the literature on hypotensive anesthesia in Functional Endoscopic Sinus Surgeries (FESS), crucial for treating sinonasal disorders. The anesthesia technique choice significantly influences FESS outcomes. Hypotensive anesthesia, involving controlled blood pressure reduction during surgery, garners attention for potential benefits. A database search identified relevant studies examining its efficacy, safety, and impact on intraoperative visibility, surgical time, blood loss, and postoperative outcomes. Various drugs, including inhalational agents, hypocapnia, hypercapnia, local adrenaline, fentanyl, remifentanil, esmolol, dexmedetomidine, and nitroglycerine, have been employed to minimize bleeding and enhance operative conditions. Sevoflurane is a common inhalation agent. Dexmedetomidine, with lower bolus doses, proves advantageous for visibility and achieving a MAP of 60 mm Hg swiftly. Opioids have a lower hypotensive potential, nitroglycerine lacks analgesic effects, and beta-blockers provide favorable conditions. Dexmedetomidine's prolonged analgesia correlates with improved postoperative outcomes. Limited studies explore combined drugs' efficacy or side effects. Cognitive dysfunction is a concern, with hypotension approved up to a MAP of 60 mm Hg. The technique's application extends to children, but careful patient selection is crucial, considering contraindications and comorbidities.