Comparison of Intravenous and Nebulized Dexmedetomidine for Surgical Field Visualization in Functional Endoscopic Sinus Surgeries: A Randomized Controlled Study

INTRODUCTION: Functional endoscopic sinus surgery (FESS) requires optimal surgical field visualization. This study was conducted to compare the efficacy of intravenous (IV) and nebulized dexmedetomidine on surgical field visualization in FESS. METHODS: The study population (n = 114) was randomly divided into group A (nebulized dexmedetomidine), group B (IV dexmedetomidine), and group C (normal saline). The primary outcome was to compare the efficacy of IV and nebulized dexmedetomidine on surgical field visualization. The secondary outcomes were to evaluate the hemodynamic response to laryngoscopy and intubation, and to compare blood loss, sedative effects, postoperative sore throat (POST), and postoperative nausea and vomiting (PONV). RESULTS: Both groups A and B provided optimal surgical field visualization, but group A maintained it for a longer duration (p < 0.05). After laryngoscopy, both groups A and B attenuated the response; however, the increase in heart rate was significantly lower in group B. There was no significant difference in blood pressure between groups A and B (p > 0.05). Both groups A and B reduced blood loss, reduced POST, and reduced PONV (p > 0.05). Group B was better at preventing a fall in postoperative hemoglobin (p = 0.009) and hematocrit (p = 0.006). Group B produced more sedation than group A, although not clinically significant (p > 0.05). CONCLUSIONS: Both IV and nebulized dexmedetomidine at 1 mcg/kg provided optimal surgical field visualization, attenuated the response to laryngoscopy and intubation and reduced blood loss, POST, and PONV. However, nebulized dexmedetomidine provided surgical field visualization for a longer duration, and IV dexmedetomidine better prevented the postoperative hemoglobin and hematocrit reduction.