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

•Both MgSO4 and diltiazem reduce blood loss in FESS when added to propofol-based anesthesia, MgSO4 being significantly more effective in producing a cleaner surgical field.•At the dosage used, neither MgSO4 nor diltiazem produced any significant change in hemodynamics compared with saline control.•The improvement may be attributed to stabilization of microfluctuations in blood pressure by these agents.

Study objectiveThis 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.DesignRandomized, double-blinded, placebo-controlled trial.SettingOperating room.PatientsForty-five American Society of Anesthesiologists I and II adult patients (18-60 years) undergoing FESS.InterventionsAll 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).MeasurementsIntraoperative bleeding was quantified, and quality of surgical field was graded. Hemodynamic parameters were recorded.Main resultsAddition 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).ConclusionIt 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).