{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T03:54:59Z","timestamp":1777002899206,"version":"3.51.4"},"reference-count":70,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec id=\"ab-ooi250096-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Excessive bleeding during endoscopic sinus surgery (ESS) impairs visualization and increases complications. Controlled hypotension is widely used; however, comparative effectiveness of available pharmacological agents remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250096-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the effectiveness and safety of hypotensive drugs for reduced bleeding in ESS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250096-6\">\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>PubMed, Scopus, Web of Science, and Cochrane databases were searched from inception to December 2024, and updated to include studies up to May 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250096-7\">\n                    <jats:title>Study Selection<\/jats:title>\n                    <jats:p>Randomized clinical trials of patients undergoing ESS and receiving dexmedetomidine, clonidine, esmolol, labetalol, bisoprolol, metoprolol, diltiazem, nifedipine, or verapamil vs placebo. A total of 1258 records were screened.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250096-8\">\n                    <jats:title>Data Extraction and Synthesis<\/jats:title>\n                    <jats:p>Data were extracted and assessed using the Cochrane risk of bias tool. Certainty was rated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. A random-effects meta-analysis was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250096-9\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Surgical bleeding score, intraoperative mean arterial pressure (MAP), and mean intraoperative heart rate. Secondary outcomes included blood loss, surgery duration, and emergence time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250096-10\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis included 52 randomized clinical trials involving 3526 participants; of these, 43 studies contributed to the network analysis. Several agents were associated with reduced bleeding vs placebo: diltiazem (mean difference [MD], \u22121.25; 95% CI, \u22122.13 to \u22120.37), esmolol (MD, \u22121.16; 95% CI, \u22121.80 to \u22120.51), dexmedetomidine (MD, \u22121.09; 95% CI, \u22121.48 to \u22120.70), labetalol (MD, \u22121.00; 95% CI, \u22121.58 to \u22120.42), and clonidine (MD, \u22120.69; 95% CI, \u22121.23 to \u22120.16). Dexmedetomidine was associated with the most reduced MAP (MD, \u221230.30 mm Hg; 95% CI, \u221247.91 to \u221212.69), followed by clonidine (MD, \u221228.61; 95% CI, \u221253.11 to \u22124.11), esmolol (MD, \u221227.62; 95% CI, \u221249.73 to \u22125.51), and labetalol (MD, \u221226.54; 95% CI, \u221247.20 to \u22125.87). At 60 minutes, bisoprolol (MD, \u221258.30; 95% CI, \u221267.50 to \u221249.10 beats per minute [bpm]), verapamil (MD, \u221249.90; 95% CI, \u221258.98 to \u221240.82 bpm), and labetalol (MD, \u221243.89; 95% CI, \u221254.59 to \u221233.18 bpm) produced the largest heart rate reductions. Esmolol (MD, \u22123.67; 95% CI, \u22124.21 to \u22123.13 minutes) and labetalol (MD, \u22123.64; 95% CI, \u22124.79 to \u22122.49 minutes) shortened emergence time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250096-11\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this systematic review and network meta-analysis, controlled hypotension improved surgical field quality in ESS with comparable safety. Diltiazem, esmolol, dexmedetomidine, labetalol, and clonidine were effective; dexmedetomidine was associated with reduced MAP the most, and esmolol favored recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoto.2025.5222","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T16:30:32Z","timestamp":1769704232000},"page":"346","source":"Crossref","is-referenced-by-count":2,"title":["Hypotensive Agents for Controlled Hypotension in Endoscopic Sinus Surgery"],"prefix":"10.1001","volume":"152","author":[{"given":"Abdelrahman","family":"Saeed","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Damietta, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Saeed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Damietta, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamedhen Vall","family":"Nounou","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Nouakchott Al Aasrya, Nouakchott, Mauritania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward D.","family":"McCoul","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Ochsner Health, New Orleans, Louisiana"},{"name":"Associate Editor, JAMA Otolaryngology\u2013Head & Neck Surgery."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qasi","family":"Najah","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Elmergib University, Alkhums, Libya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Saleh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The Hashemite University, Zarqa, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osama","family":"Barakat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Aleppo, Aleppo, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Wahhab","sequence":"additional","affiliation":[{"name":"Hammurabi College of Medicine, University of Babylon, Babil, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Longgang","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammed","family":"Elhadi","sequence":"additional","affiliation":[{"name":"College of Medicine, Korea University, Anam-ro, Seongbuk-gu, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"issue":"3","key":"ooi250096r1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.bjorl.2019.08.008","article-title":"The efficacy of esmolol, remifentanil and nitroglycerin in controlled hypotension for functional endoscopic sinus surgery.","volume":"87","author":"Alkan","year":"2021","journal-title":"Braz J Otorhinolaryngol"},{"issue":"2","key":"ooi250096r2","doi-asserted-by":"publisher","first-page":"67","DOI":"10.3329\/jbsa.v31i2.66489","article-title":"Controlled hypotension for functional endoscopic sinus surgery: a comparative study between dexmedetomidine versus esmolol.","volume":"31","author":"Shaheen","year":"2018","journal-title":"Journal of the Bangladesh Society of Anaesthesiologists"},{"issue":"1","key":"ooi250096r3","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1002\/alr.20101","article-title":"Nationwide incidence of major complications in endoscopic sinus surgery.","volume":"2","author":"Ramakrishnan","year":"2012","journal-title":"Int Forum Allergy Rhinol"},{"issue":"1","key":"ooi250096r4","doi-asserted-by":"publisher","first-page":"59","DOI":"10.4103\/0970-9185.125705","article-title":"Oral bisoprolol improves surgical field during functional endoscopic sinus surgery.","volume":"30","author":"Jacob","year":"2014","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"7","key":"ooi250096r5","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1007\/s00405-012-2311-1","article-title":"Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery.","volume":"270","author":"Milonski","year":"2013","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"1","key":"ooi250096r6","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12871-015-0034-8","article-title":"Effect of desmopressin administration on intraoperative blood loss and quality of the surgical field during functional endoscopic sinus surgery: a randomized, clinical trial.","volume":"15","author":"Shao","year":"2015","journal-title":"BMC Anesthesiol"},{"issue":"1","key":"ooi250096r7","doi-asserted-by":"publisher","first-page":"79","DOI":"10.4103\/JCMRP.JCMRP_68_18","article-title":"Comparative study between the efficacy of oral verapamil and bisoprolol on reduction of intraoperative bleeding during endoscopic sinus surgery under general anesthesia.","volume":"9","author":"Ali","year":"2024","journal-title":"Journal of Current Medical Research and Practice"},{"issue":"1","key":"ooi250096r8","doi-asserted-by":"publisher","first-page":"14765","DOI":"10.18502\/aacc.v10i1.14765","article-title":"Comparison of clonidine versus esmolol in controlled hypotension in patients undergoing FESS surgery.","volume":"10","author":"Garg","year":"2024","journal-title":"Arch Anesth Crit Care"},{"key":"ooi250096r9","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.681471","article-title":"Effect of deliberate hypotension on regional cerebral oxygen saturation during functional endoscopic sinus surgery: a randomized controlled trial.","volume":"8","author":"Zhang","year":"2021","journal-title":"Front Surg"},{"issue":"10","key":"ooi250096r10","first-page":"91","article-title":"Comparison of dexmedetomidine, with clonidine based anaesthesia for controlled hypotension in functional endoscopic sinus surgery.","volume":"18","author":"Praveen","year":"2024","journal-title":"Res J Med Sci"},{"issue":"4","key":"ooi250096r11","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1177\/17504589241252107","article-title":"Dexmedetomidine and surgical field visibility in nasal surgery: a systematic review and meta-analysis.","volume":"35","author":"Warner","year":"2025","journal-title":"J Perioper Pract"},{"issue":"11","key":"ooi250096r12","doi-asserted-by":"publisher","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann Intern Med"},{"key":"ooi250096r13","doi-asserted-by":"publisher","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"issue":"6","key":"ooi250096r14","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1213\/00000539-198606000-00021","article-title":"Controlled hypotension for orthognathic surgery.","volume":"65","author":"Fromme","year":"1986","journal-title":"Anesth Analg"},{"issue":"5 Pt 1","key":"ooi250096r15","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1007\/BF03015479","article-title":"Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery.","volume":"42","author":"Boezaart","year":"1995","journal-title":"Can J Anaesth"},{"key":"ooi250096r16","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials.","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"issue":"7650","key":"ooi250096r17","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"issue":"7109","key":"ooi250096r19","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test.","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ooi250096r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcorm.2022.100295","article-title":"Efficacy of oral diltiazem on the intraoperative bleeding in functional endoscopic sinus surgery.","volume":"30","author":"Abdel-wahab","year":"2023","journal-title":"Perioper Care Oper Room Manag"},{"issue":"4","key":"ooi250096r21","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.egja.2014.04.001","article-title":"Efficacy of different dexmedetomidine regimens in producing controlled hypotensive anesthesia during functional endoscopic sinus surgery.","volume":"30","author":"Abel Rahman","year":"2014","journal-title":"Egypt J Anaesth"},{"issue":"8","key":"ooi250096r22","doi-asserted-by":"publisher","first-page":"579","DOI":"10.4103\/ija.IJA_57_21","article-title":"Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery: a randomised, double-blind interventional study.","volume":"65","author":"Bafna","year":"2021","journal-title":"Indian J Anaesth"},{"issue":"2","key":"ooi250096r23","doi-asserted-by":"publisher","first-page":"192","DOI":"10.4103\/0970-9185.173325","article-title":"Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: a comparative evaluation.","volume":"32","author":"Bajwa","year":"2016","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"37","key":"ooi250096r24","doi-asserted-by":"publisher","first-page":"9556","DOI":"10.14260\/jemds\/2014\/3236","article-title":"Controlled hypotensive anaesthesia with dexmedetomidine for functional endoscopic sinus surgery: a prospective randomized double blind study.","volume":"3","author":"Chiruvella","year":"2014","journal-title":"J Evol Med Dent Sci"},{"issue":"2","key":"ooi250096r25","doi-asserted-by":"publisher","first-page":"197","DOI":"10.33545\/26643766.2021.v4.i2c.255","article-title":"Dexmedetomidine and esmolol for induced hypotension for functional endoscopic sinus surgery: a comparative study.","volume":"4","author":"Damarla","year":"2021","journal-title":"Int J Med Anesthesiol."},{"issue":"1","key":"ooi250096r26","first-page":"23","article-title":"Comparison between two different regimens of dexmedetomidine in functional endoscopic sinus surgery: a prospective, randomized double blind study.","volume":"29","author":"Das","year":"2022","journal-title":"Middle East J Anaesthesiol"},{"issue":"3","key":"ooi250096r27","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4103\/fjs.fjs_131_17","article-title":"Hypotensive effect of labetalol and dexmedetomidine blood loss and surgical conditions in functional endoscopic sinus surgery: a double-blind randomized clinical trial.","volume":"51","author":"Eghbal","year":"2018","journal-title":"Formos J Surg"},{"issue":"11","key":"ooi250096r28","doi-asserted-by":"publisher","first-page":"3095","DOI":"10.1007\/s00405-019-05575-6","article-title":"Randomized clinical trial to compare the efficacy to improve the quality of surgical field of hypotensive anesthesia with clonidine or dexmedetomidine during functional endoscopic sinus surgery.","volume":"276","author":"Escamilla","year":"2019","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"ooi250096r29","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2023\/62730.18286","article-title":"Impact of dexmedetomidine infusion during functional endoscopic sinus surgery: a randomised controlled trial.","volume":"17","author":"Fernandes","year":"2023","journal-title":"J Clin Diagn Res"},{"issue":"1","key":"ooi250096r30","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1017\/S0265021507001317","article-title":"Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia.","volume":"25","author":"Goksu","year":"2008","journal-title":"Eur J Anaesthesiol"},{"issue":"4","key":"ooi250096r31","doi-asserted-by":"publisher","DOI":"10.5812\/aapm.12682","article-title":"The effect of intravenous infusion of dexmedetomidine to prevent bleeding during functional endoscopic sinus surgery: a clinical trial.","volume":"7","author":"Gousheh","year":"2017","journal-title":"Anesth Pain Med"},{"issue":"4","key":"ooi250096r32","doi-asserted-by":"publisher","first-page":"652","DOI":"10.35975\/apic.v28i4.2507","article-title":"Dexmedetomidine versus labetalol for induced hypotension during functional endoscopic sinus surgery: a randomized, double-blind study.","volume":"28","author":"Gupta","year":"2024","journal-title":"Anaesth Pain Intensive Care"},{"issue":"9","key":"ooi250096r33","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1177\/000348941112000906","article-title":"Evaluation of outcomes in patients given dexmedetomidine in functional endoscopic sinus surgery.","volume":"120","author":"Guven","year":"2011","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"1","key":"ooi250096r34","doi-asserted-by":"publisher","DOI":"10.5812\/aapm.108915","article-title":"To compare the efficacy of dexmedetomidine versus labetalol in providing controlled hypotension in functional endoscopic sinus surgery.","volume":"11","author":"J N","year":"2021","journal-title":"Anesth Pain Med"},{"issue":"1","key":"ooi250096r35","first-page":"25","article-title":"Oral clonidine premedication decreases intraoperative bleeding in patients undergoing endoscopic sinus surgery.","volume":"10","author":"Jabalameli","year":"2005","journal-title":"Res Med Sci"},{"issue":"10","key":"ooi250096r36","doi-asserted-by":"publisher","first-page":"1970","DOI":"10.9734\/BJMMR\/2014\/4168","article-title":"Evaluation of oral clonidine premedication on intraoperative blood loss and bleeding severity score in functional endoscopic sinus surgery\u2013a prospective placebo controlled study.","volume":"4","author":"Jan","year":"2014","journal-title":"Br J Med Med Res"},{"issue":"5","key":"ooi250096r37","doi-asserted-by":"publisher","first-page":"418","DOI":"10.4103\/ija.IJA_58_17","article-title":"Intravenous clonidine as a part of balanced anaesthesia for controlled hypotension in functional endoscopic sinus surgery: a randomised controled trial.","volume":"61","author":"Jiwanmall","year":"2017","journal-title":"Indian J Anaesth"},{"issue":"12","key":"ooi250096r38","first-page":"342","article-title":"Comparison of dexmedetomidine and esmolol induced hypotension in functional endoscopic sinus surgery.","volume":"15","author":"Joshi","year":"2023","journal-title":"International Journal of Current Pharmaceutical Review and Research"},{"issue":"11","key":"ooi250096r39","first-page":"896","article-title":"Comparative study of perioperative infusion of dexmedetomidine versus labetalol for controlled hypotension in functional endoscopic sinus surgeries.","volume":"15","author":"Kattishettar","year":"2023","journal-title":"International Journal of Current Pharmaceutical Review and Research"},{"issue":"4","key":"ooi250096r40","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.37918","article-title":"A study of the effect of pre-emptive oral clonidine on intraoperative haemodynamics and surgical field quality during functional endoscopic sinus surgery under general anaesthesia.","volume":"15","author":"Khandelwal","year":"2023","journal-title":"Cureus"},{"issue":"3","key":"ooi250096r41","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e25175","article-title":"Premedication with intranasal versus intravenous dexmedetomidine for hypotensive anesthesia during functional endoscopic sinus surgery in adults: a randomized triple-blind trial.","volume":"10","author":"Kohaf","year":"2024","journal-title":"Heliyon"},{"key":"ooi250096r42","doi-asserted-by":"publisher","DOI":"10.1177\/1179550619847992","article-title":"Blood loss and visibility with esmolol vs labetalol in endoscopic sinus surgery: a randomized clinical trial.","volume":"12","author":"Lavere","year":"2019","journal-title":"Clin Med Insights Ear Nose Throat"},{"issue":"34","key":"ooi250096r43","doi-asserted-by":"publisher","first-page":"2789","DOI":"10.14260\/Jemds\/2017\/601","article-title":"Comprehensive study on effectiveness and advantages of dexmedetomidine and esmolol in controlled hypotension for functional endoscopic sinus surgery.","volume":"6","author":"Ravikumar M, Shanmugasundaram P.","year":"2017","journal-title":"J Evol Med Dent Sci"},{"key":"ooi250096r44","doi-asserted-by":"publisher","first-page":"19","DOI":"10.36106\/ijsr\/0100895","article-title":"Clonidine 100mcg versus 200 mcg as the main stay for circulatory manipulation in functional endoscopic sinus surgery: a randomised comparative study.","author":"Goswami","year":"2022","journal-title":"Int J Sci Res"},{"issue":"4","key":"ooi250096r45","doi-asserted-by":"publisher","first-page":"578","DOI":"10.4103\/aer.AER_19_21","article-title":"Premedication for induced hypotension in functional endoscopic sinus surgeries: intravenous dexmedetomidine infusion vs oral metoprolol vs placebo: a comparative study.","volume":"14","author":"Mahajan","year":"2020","journal-title":"Anesth Essays Res"},{"issue":"1","key":"ooi250096r46","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1080\/11101849.2024.2331359","article-title":"A comparative study between the effect of intravenous versus intranasal dripping of dexmedetomidine on intraoperative blood loss during functional endoscopic nasal sinus surgery.","volume":"40","author":"Mohamed Hassan","year":"2024","journal-title":"Egypt J Anaesth"},{"issue":"4","key":"ooi250096r47","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1007\/s00540-011-1157-9","article-title":"The effect of oral clonidine premedication on blood loss and the quality of the surgical field during endoscopic sinus surgery: a placebo-controlled clinical trial.","volume":"25","author":"Mohseni","year":"2011","journal-title":"J Anesth"},{"issue":"1","key":"ooi250096r48","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1186\/s12871-024-02809-x","article-title":"Clonidine and dexmedetomidine for controlled hypotension during functional endoscopic sinus surgery: a comparative study.","volume":"24","author":"Mugabo","year":"2024","journal-title":"BMC Anesthesiol"},{"issue":"6","key":"ooi250096r49","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1097\/00005537-200406000-00016","article-title":"The effect of \u00df-blocker premedication on the surgical field during endoscopic sinus surgery.","volume":"114","author":"Nair","year":"2004","journal-title":"Laryngoscope"},{"issue":"106","key":"ooi250096r50","first-page":"281","article-title":"Dexmedetomidine efficacy in quality of surgical field during endoscopic sinus surgery.","volume":"31","author":"Parvizi","year":"2019","journal-title":"Iran J Otorhinolaryngol"},{"issue":"3","key":"ooi250096r51","doi-asserted-by":"publisher","first-page":"371","DOI":"10.4103\/0259-1162.123244","article-title":"A comparison of effects of oral premedication with clonidine and metoprolol on intraoperative hemodynamics and surgical conditions during functional endoscopic sinus surgery.","volume":"7","author":"Puthenveettil","year":"2013","journal-title":"Anesth Essays Res"},{"issue":"1","key":"ooi250096r52","doi-asserted-by":"publisher","first-page":"38","DOI":"10.4193\/Rhino15.085","article-title":"Intranasal atomised dexmedetomidine optimises surgical field visualisation with decreased blood loss during endoscopic sinus surgery: a randomized study.","volume":"54","author":"Qiao","year":"2016","journal-title":"Rhinology"},{"issue":"3","key":"ooi250096r53","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.jrras.2022.05.005","article-title":"Dexmedetomidine reduces oxidative stress in patients with controlled hypotension undergoing functional endoscopic surgery.","volume":"15","author":"Qiu","year":"2022","journal-title":"J Radiat Res Appl Sci"},{"issue":"1","key":"ooi250096r54","doi-asserted-by":"publisher","first-page":"12","DOI":"10.5222\/jarss.2020.70883","article-title":"Effectiveness of dexmedetomidine for controlled hypotension in providing optimum surgical conditions for functional endoscopic sinus surgeries: a double-blinded randomized controlled trial.","volume":"28","author":"Raja Neethirajan","year":"2020","journal-title":"J Anesth Reanim Spec Soc"},{"issue":"2","key":"ooi250096r55","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000497045","article-title":"Metoprolol significantly improves visual clarity and hemodynamic parameters during functional endoscopic sinus surgery.","volume":"4","author":"Sadek","year":"2019","journal-title":"Biomed Hub"},{"issue":"5","key":"ooi250096r56","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.15069","article-title":"Induced hypotension in functional endoscopic sinus surgery: a comparative study of dexmedetomidine and esmolol.","volume":"13","author":"Sahu","year":"2021","journal-title":"Cureus"},{"issue":"1","key":"ooi250096r57","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3329\/bjo.v24i1.45340","article-title":"Controlled hypotension for functional endoscopic sinus surgery: a comparative study of dexmedetomidine and esmolol.","volume":"24","author":"Shaheen","year":"2020","journal-title":"Bangladesh J Otorhinolaryngol"},{"issue":"2","key":"ooi250096r58","doi-asserted-by":"publisher","first-page":"175","DOI":"10.4103\/1658-354X.114073","article-title":"Induced hypotension for functional endoscopic sinus surgery: a comparative study of dexmedetomidine versus esmolol.","volume":"7","author":"Shams","year":"2013","journal-title":"Saudi J Anaesth"},{"issue":"6","key":"ooi250096r59","doi-asserted-by":"publisher","first-page":"e208","DOI":"10.2500\/ajra.2011.25.3701","article-title":"Intravenous esmolol infusion improves surgical fields during sevoflurane-anesthetized endoscopic sinus surgery: a double-blind, randomized, placebo-controlled trial.","volume":"25","author":"Shen","year":"2011","journal-title":"Am J Rhinol Allergy"},{"issue":"10","key":"ooi250096r60","doi-asserted-by":"publisher","first-page":"4485","DOI":"10.1007\/s00405-023-08017-6","article-title":"Does preoperative administration of hypotensive agents affect the quality of the surgical field during endoscopic sinus surgery? A triple-blind randomized controlled trial.","volume":"280","author":"Skalias","year":"2023","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"10","key":"ooi250096r61","first-page":"11","article-title":"Pre-operative oral bisoprolol improves the surgical field during functional endoscopic sinus surgery: a randomized, controlled, prospective and double-blinded study.","volume":"2","author":"Sophia","year":"2015","journal-title":"Int J Sci Stud"},{"issue":"35","key":"ooi250096r62","doi-asserted-by":"publisher","first-page":"2014","DOI":"10.14260\/jemds\/2016\/473","article-title":"Clonidine premedication as a desirable part of hypotensive anaesthesia for functional endoscopic sinus surgery.","volume":"5","author":"Praveen","year":"2016","journal-title":"J Evol Med Dent Sci"},{"issue":"4","key":"ooi250096r63","doi-asserted-by":"publisher","first-page":"659","DOI":"10.4103\/joacp.joacp_234_23","article-title":"Comparative evaluation of oral premedication with clonidine and metoprolol on surgical field conditions and intraoperative hemodynamics during functional endoscopic sinus surgery.","volume":"40","author":"Naithani","year":"2024","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"1","key":"ooi250096r64","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1186\/s12871-022-01711-8","article-title":"A randomized placebo-controlled double-blind study of dexmedetomidine on postoperative sleep quality in patients with endoscopic sinus surgery.","volume":"22","author":"Wu","year":"2022","journal-title":"BMC Anesthesiol"},{"issue":"5","key":"ooi250096r65","first-page":"8405","article-title":"Effects of dexmedetomidine on the recovery profiles from general anesthesia in patients undergoing endoscopic sinus surgery.","volume":"9","author":"Xu","year":"2016","journal-title":"Int J Clin Exp Med"},{"issue":"3","key":"ooi250096r66","first-page":"214","article-title":"Dexmedetomidine versus esmolol for induced hypotension during functional endoscopic sinus surgery-a prospective randomised comparative study.","volume":"14","author":"Geetanjali","year":"2024","journal-title":"Eur J Cardiovasc Med"},{"issue":"6","key":"ooi250096r67","first-page":"1005","article-title":"Comparative evaluation of the hypotensive effects of clonidine to dexmedetomidine during functional endoscopic sinus surgery in the induction of hypotension: an interventional study.","volume":"12","author":"Lahari","year":"2021","journal-title":"J Cardiovasc Dis Res"},{"issue":"S2","key":"ooi250096r68","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1007\/s12070-013-0655-5","article-title":"Controlled hypotension for functional endoscopic sinus surgery: comparison of esmolol and nitroglycerine.","volume":"65","author":"Srivastava","year":"2013","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"issue":"S3","key":"ooi250096r69","doi-asserted-by":"publisher","first-page":"S8","DOI":"10.1017\/S0022215115001334","article-title":"Dexmedetomidine improves the quality of the operative field for functional endoscopic sinus surgery: systematic review.","volume":"129","author":"Snidvongs","year":"2015","journal-title":"J Laryngol Otol"},{"issue":"2","key":"ooi250096r70","doi-asserted-by":"publisher","first-page":"95","DOI":"10.4103\/2229-516X.136788","article-title":"Dexmedetomidine versus esmolol to attenuate the hemodynamic response to laryngoscopy and tracheal intubation: a randomized double-blind clinical study.","volume":"4","author":"Reddy","year":"2014","journal-title":"Int J Appl Basic Med Res"},{"key":"ooi250096r18","doi-asserted-by":"crossref","DOI":"10.1002\/9780470743386","volume-title":"Introduction to Meta-Analysis","author":"Borenstein","year":"2009"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2844255\/jamaotolaryngology_saeed_2026_oi_250096_1775660473.69193.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T15:00:32Z","timestamp":1775746832000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2844255"}},"subtitle":["A Systematic Review and Network Meta-Analysis"],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":70,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2025.5222","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}