Optimizing Hemodynamic Stability and Surgical Field Clarity in Functional Endoscopic Sinus Surgery: The Roles of Metoprolol and Dexmedetomidine

Abstract

Endotracheal intubation often elicits a significant physiological stress response, leading to hemodynamic instability that can impact perioperative outcomes. In functional endoscopic sinus surgery (FESS), maintaining hemodynamic stability and ensuring a clear surgical field are critical for optimizing surgical success. This review examines the efficacy and safety of two pharmacological agents—metoprolol, a selective beta-1 adrenergic blocker, and dexmedetomidine, a selective alpha-2 adrenergic agonist—in attenuating the stress response to endotracheal intubation and improving surgical field conditions during FESS. We provide a comprehensive analysis of clinical and pharmacological evidence, focusing on the mechanisms of action, dosing strategies, and hemodynamic effects of each agent. Metoprolol effectively reduces heart rate and blood pressure surges during intubation, while dexmedetomidine offers advantages such as sedation, analgesia, and controlled hypotension, which contribute to reduced intraoperative bleeding and improved visibility in the surgical field. Furthermore, studies suggest a potential synergistic effect when these agents are used in combination, enhancing overall perioperative stability and surgical conditions. This review highlights the clinical implications of using metoprolol and dexmedetomidine in FESS, addressing their roles in minimizing complications and improving patient outcomes. It also identifies gaps in the existing literature and proposes directions for future research, aiming to guide anesthesiologists and surgeons in tailoring perioperative pharmacological strategies for enhanced surgical precision and safety.