Preoperative Ivabradine Doses for Hemodynamic Stability in FESS

Comparison of Two Preoperative Ivabradin Regimens for Hemodynamic Stability During Functional Endoscopic Sinus Surgery

This study compares two different preoperative doses of a heart-rate-lowering medication called ivabradine in patients undergoing endoscopic sinus surgery under general anesthesia. Patients will receive either a lower dose, a higher dose, or a placebo (inactive pill) before surgery. The goal is to see which approach best keeps blood pressure and heart rate stable during surgery, and whether it reduces bleeding and improves the surge

This is a prospective, randomized, double-blind, placebo-controlled, parallel-group trial conducted at Minia University Hospital. Eighty-four patients aged 21-60 years, ASA physical status I or II, scheduled for functional endoscopic sinus surgery (FESS) under general anesthesia, with a baseline heart rate of 70 beats per minute or higher in sinus rhythm, will be randomly allocated into three equal groups. Group A will receive ivabradine 5 mg the night before surgery plus 5 mg on the morning of surgery; Group B will receive ivabradine 5 mg the night before plus 7.5 mg on the morning of surgery; Group C will receive a placebo (folic acid) on both occasions. Randomization codes will be concealed in sequentially numbered opaque sealed envelopes, and study medication will be prepared by an independent pharmacist to maintain blinding. Hemodynamic parameters will be recorded at standardized time points throughout the perioperative period. Surgical field visibility will be assessed using the Boezaart Bleeding Scale, and recovery will be assessed using the modified Aldrete Score. The study aims to determine which ivabradine regimen provides superior hemodynamic stability and surgical field conditions during FESS.

Inclusion Criteria:

• Age between 21 and 60 years of both sexes
• ASA physical status I or II
• Baseline heart rate ≥ 70 beats per minute in sinus rhythm on preoperative ECG

Exclusion Criteria:

• Patient refusal or inability to provide informed consent
• Baseline heart rate <70 beats per minute or any degree of heart block on preoperative ECG
• Current use of beta blockers, calcium channel blockers, digoxin, or any antiarrhythmic agent
• Severe hepatic impairment (Child-Pugh class C) or renal impairment (eGFR<30 ml/min)
• Pregnancy or breastfeeding