Efficacy of intraoperative dexmedetomidine infusion on visualization of the surgical field in endoscopic sinus surgery

Background: In endoscopic sinus surgery, visualization of the surgical field is a major concern, as surgical bleeding is the cause of many complications. The purpose of this study was to compare the effects of dexmedetomidine and remifentanil on the visualization of the surgical field in endoscopic sinus surgery. Methods: Forty-three patients were prospectively enrolled and randomly allocated to the dexmedetomidine or remifentanil group and general anesthesia was induced and maintained using a propofol target-controlled infusion. In the dexmedetomidine group, dexmedetomidine was loaded for 5 min and a continuous infusion was administered. In the remifentanil group, a remifentanil target-controlled infusion was used. After completion of the operation, the satisfaction with the visualization of the surgical field was assessed on a numeric rating scale, from 0 (= worst) to 10 (= best). The mean blood pressure, heart rate, recovery profiles, and postoperative pain score were recorded. Results: Satisfaction score for visualization by numeric rating scale was not significantly different between the two groups (P = 0.95). There were no differences in the mean blood pressure and heart rate. The extubation time was significantly shorter in the dexmedetomidine group (8.4 +/- 1.8 min) than in the remifentanil group (11.9 +/- 5.4 min) (P = 0.04). Except for the extubation time, the recovery profiles of the two groups were comparable. Conclusions: Continuous infusions of dexmedetomidine provide a similar visualization of the surgical field and hemodynamic stability as remifentanil target-controlled infusions in patients undergoing endoscopic sinus surgery.