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Background: FESS – Functional endoscopic sinus surgery, a minimally invasive surgery, has become the main stay for treatment of patients with sinus pathology. However, Intraoperative bleeding, which reduces operative field visibility is the major problem in FESS. This study compare the effects of preoperative Clonidine, Metoprolol and Tranexamic acid with Intraoperative Nitroglycerin in patients undergoing FESS on Quality of surgical field , Intraoperative blood loss ,Hemodynamics and duration of surgery. Methods: In this study 90 patients assigned to undergo FESS were randomly allocated to three groups of 30 each. Group 1 patients were premedicated orally with Metoprolol 12.5 mg and Clonidine150mcg. Inj.Tranexamic Acid 30 mg/kg i.v. was given half an hour prior to surgery. Group II patients received NTG infusion at 2-5 mcg/kg/min, titrated to a mean arterial blood pressure of 65-75 mm/Hg. Group III underwent surgery under normotensive anesthesia. Results: Visibility of the operative field was best in Group II when compared to Group I, which was relatively better than control group. The average blood loss and mean arterial pressure was least with Group II. Mean heart rate was significantly low in Metoprolol, Clonidine and Tranexamic acid group. Conclusion : Nitroglycerin infusion have lesser blood loss, better quality of surgical field and reduced duration of surgery compared to premedication with Metoprolol, Clonidine and Tranexamic acid and normotensive anesthesia but in conditions where nitroglycerin infusion is contraindicated or not feasible, the use of Metoprolol, clonidine and Tranexamic acid may be an acceptable safer and simpler alternative.

iosr journal of dental and medical sciences

A Comparison of Premedication with Metoprolol, Clonidine and Tranexamic Acid and Intravenous Nitroglycerin on Intraoperative Hemodynamics and Surgical Conditions during Functional Endoscopic Sinus Surgery (Fess).