Effects of Premedication with Metoprolol on Bleeding and Induced Hypotension in Nasal Surgery

Rahimzadeh, Poupak; Faiz, Seyed Hamid Reza; Alebouyeh, Mardawig

doi:10.5812/aapm.3408

Cited by 10 publications

(7 citation statements)

References 11 publications

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“…We observed temporary hypertension in 4 patients and temporary and completely reversible ST changes in 2 patients 25) 61 (19) .80…”

Section: Unintended Effectsmentioning

confidence: 73%

“…As MAP is proportional to SVR and CO, the effects of vasodilators and negative inotropic and chronotropic drugs have been tested. Sodium nitroprusside 4 and nitroglycerin 18 have no advantage, whereas preoperative metoprolol administration, 19 intraoperative labetolol, 20 or intraoperative esmolol administration consistently led to improved conditions 4,21,22 . Studies using magnesium sulfate came to positive 22 and negative conclusions 23 .…”

Section: Discussionmentioning

confidence: 99%

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Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol‐ vs Desflurane‐Based Anesthesia

Gollapudy

Gashkoff

Poetker

et al. 2020

Otolaryngol.--head neck surg.

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Objective To assess if the type of general anesthetic affects bleeding and field visualization during endoscopic sinus surgery. Study Design Prospective, randomized, controlled trial. Setting Academic teaching hospital and Veterans Affairs hospital in the United States. Subjects and Methods Seventy patients were randomized to 1 of 3 anesthetic regimens: (1) the volatile anesthetic desflurane (n = 22), (2) intravenous anesthesia with propofol (n = 25), or (3) a combination of propofol and desflurane (n = 23). Intravenous remifentanil was titrated to decrease the mean arterial pressure to 60 to 70 mm Hg but not ≥30% from baseline. Surgical bleeding scores were recorded along with bleeding rates and hemodynamic parameters, including cardiac output and systemic vascular resistance through pulse contour analysis from a radial arterial line. Statistics: multiple comparison tests and regression analyses; α = .05. Results There were no differences in bleeding rate (median, 0.58, 0.85, 0.57 mL min–1), bleeding score (2.1, 2.0, 2.0), surgery duration (79, 81, 86 minutes), extubation time (9, 7, 8 minutes), recovery room time (65, 61, 61 minutes), or any hemodynamic parameters among groups 1 through 3, respectively. Group 1 required lower remifentanil infusions than group 2 (0.11 vs 0.26 µg kg–1 min–1; P = .01). The bleeding score correlated positively with height ( P = .014) and the Lund-MacKay score ( P = .013). Bilateral vs unilateral surgery led to longer surgery duration ( P = .001) and recovery room time ( P = .004). Conclusion When remifentanil is used for controlled hypotension, propofol has no advantage over desflurane to improve surgical field visualization during functional endoscopic sinus surgery.

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“…We observed temporary hypertension in 4 patients and temporary and completely reversible ST changes in 2 patients 25) 61 (19) .80…”

Section: Unintended Effectsmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol‐ vs Desflurane‐Based Anesthesia

Gollapudy

Gashkoff

Poetker

et al. 2020

Otolaryngol.--head neck surg.

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“…A group of studies suggest that premedication with oral clonidine decreases intraoperative bleeding in some surgeries ( 6 , 7 ). Metoprolol has shown to decrease bleeding in nasal sinuses ( 8 ). Propofol is one of the most common anesthetic drugs used in general anesthesia, which decreases systemic blood pressure by vasodilation ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Surgical Conditions During Propofol or Isoflurane Anesthesia for Endoscopic Sinus Surgery

et al. 2013

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BackgroundThe Anesthesia planning is an important and determining factor in the amount of intraoperative hemorrhage, which can affect the rate of intraoperative and postoperative complications.ObjectivesIn this study we used two different anesthesia techniques in functional endoscopic sinus surgery (FESS) and compared the amount of hemorrhage in the two groups.Patients and MethodsIn a single–blind clinical trial, 44 patients with ASA class I and II candidate for FESS in Amir-Al-Momenin hospital in Rasht were entered the study and divided into two equal groups randomly. In both groups anesthesia was induced with propofol, remifentanil and cis. atracurium and then, infusion of propofol – remifentanil in the first group and isoflurane plus Remifentanil infusion in the second group was used for maintenance of anesthesia. Systolic blood pressure was maintained about 90 mmHg. Then on the basis of maximum allowable blood loss (MABL) formula, we calculated the percentage of hemorrhage. Finally the patients' hemorrhage was categorized into three groups (< 10%, 10-20%, > 20%). The surgeon's satisfaction from surgical field was calculated according to the Visual Analogue Scale. Then the data was statistically analyzed with T- test.ResultsThere were meaningful differences between average of hemorrhage (propofol group = 155cc, and Isoflurane group = 291.3cc; P = 0.003), and surgeon’s satisfaction (propofol group = 1.9 and Isoflurane group = 2.95; P = 0.007).ConclusionsThe amount of hemorrhage in propofol group was less than Isoflurane group and the field condition was better in propofol group than the Isoflurane group.

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“…Endotracheal intubation of the trachea stimulates laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines (adrenaline and noradrenaline), this sympathetic stimulation results in tachycardia and elevation of blood pressure (1-7). Thus diverse classes of drugs and different techniques such as; local anesthetics, opioids, calcium channel blockers, short acting β-adrenergic blockers, and their combinations have been used to prevent hemodynamic responses induced by laryngoscopy and endotracheal intubation (8-14). The hypothetical background for the use of these methods for laryngoscopy and tracheal intubation is that these adjuvant measures may be able to decrease hemodynamic responses by blocking intense sympathetic discharge caused by stimulation of the upper airway.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anesthesia

Hassani

Movassaghi

Goodarzi³

et al. 2012

Anesth Pain

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BackgroundInduction of anesthesia and endotracheal intubation often creates a period of hemodynamic instability in hypertensive patients. Endotracheal intubation of the trachea stimulates laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines.ObjectivesThis trial aimed to evaluate and compare the efficacy of fentanyl and fentanyl plus lidocaine in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation in hypertensive patients.Patients and MethodsWe conducted a prospective, randomized, double-blind trial in 37 patients with hypertension in the Rasoul-Akram Hospital, Tehran, Iran, from March to December 2011. The patients were randomly divided into two groups (fentanyl group and fentanyl plus lidocaine group). The fentanyl group received 2 mcg/kg and the fentanyl plus lidocaine group received 1.5mg lidocaine and 2mcg/kg fentanyl. Hemodynamic variables were recorded at baseline, after giving inductive anesthetic agents, and 1, 3 and 5 minutes after performing endotracheal intubation.ResultsWe evaluated 37 patients including 15 males (40.54%) and 22 females (59.46%), with a mean age of 56.08 ± 10.85 years. There were no significant differences between the two groups regarding; heart rate, systolic blood pressure and diastolic blood pressure before induction, 3 minutes before intubation and 1, 3 and 5 minutes after intubation.ConclusionsFentanyl and fentanyl plus lidocaine effectively decreased the hemodynamic response to tracheal intubation, however, neither fentanyl nor fentanyl plus lidocaine, could inhibit all hemodynamic responses, moreover fentanyl plus lidocaine was not more effective than fentanyl alone.

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Effects of Premedication with Metoprolol on Bleeding and Induced Hypotension in Nasal Surgery

Cited by 10 publications

References 11 publications

Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol‐ vs Desflurane‐Based Anesthesia

Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol‐ vs Desflurane‐Based Anesthesia

Comparison of Surgical Conditions During Propofol or Isoflurane Anesthesia for Endoscopic Sinus Surgery

Comparison of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anesthesia

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