Magnesium sulfate or diltiazem as adjuvants to total intravenous anesthesia to reduce blood loss in functional endoscopic sinus surgery

Study objective: This study was designed to know whether addition of magnesium sulfate (MgSO4) or diltiazem to total intravenous anesthesia (TIVA) (propofol) aided reduction in blood loss during functional endoscopic sinus surgery (FESS). The secondary outcomes measured were surgeon's assessment of the surgical field and hemodynamics. Design: Randomized, double-blinded, placebo-controlled trial. Setting: Operating room. Patients: Forty-five American Society of Anesthesiologists I and II adult patients (18-60 years) undergoing FESS. Interventions: All groups received propofol-fentanyl TIVA. Patients were randomly allocated to 1 of the 3 groups (MgSO4 group, n = 15; diltiazem group, n = 15; saline group, n = 15). Measurements: Intraoperative bleeding was quantified, and quality of surgical field was graded. Hemodynamic parameters were recorded. Main results: Addition of both MgSO4 and diltiazem significantly reduced blood loss (240 and 350 mL) in comparison to control group (415 mL) (P = .003). The surgical field was significantly better in the MgSO4 group compared with the diltiazem (P = .028) and saline groups (P = .0001). Conclusion: It was concluded that the addition of both MgSO4 and diltiazem to TIVA propofol results in significant reduction in blood loss and significant improvement in the quality of surgical field during FESS without causing any adverse effects on the hemodynamics or on the recovery from anesthesia. The surgical field in the MgSO4 group was significantly better than that in the diltiazem group (P = .04). (C) 2016 Elsevier Inc. All rights reserved.