Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery

The Effect of β‐Blocker Premedication on the Surgical Field During Endoscopic Sinus Surgery

“…The lowering of MAP during general anesthesia can minimize intraoperative bleeding. 7,14,18 However, controlled MAP hypotension to values ranging from 50 to 60 mm Hg has been associated with ischemic organ failure. 19 In ESS, such measures are uncommon and controversial because the aim is not to minimize blood transfusion but to improve intraoperative endoscopic visibility.…”

“…13 Such vasodilation may in fact worsen the surgical field. 14 Therefore, the minimum quantity of volatile anesthetics should be used with a suitable agent to lower blood pressure and pulse rate. Other authors have tried using sodium nitroprusside to improve the surgical field, but this causes a direct relaxant effect on the smooth muscle of veins and arteries.…”

“…A number of previous studies have aimed to assess the effects of hypotension on the surgical field during ESS. 7,14,15 The findings in these studies have been limited by inadequate sample sizes, lack of a control group, and limited data collection. The aim of the present study was to determine whether the routine use of β‐blockers as a premedication could improve the operative field in ESS.…”

Pilot Study Comparing Total Intravenous Anesthesia to Inhalational Anesthesia in Endoscopic Sinus Surgery: Novel Approach of Blood Flow Quantification

“…In fact, a considerable amount of data has shown that blood pressure and intraoperative bleeding are not necessarily related, and hypotension on its own does not improve surgical field visibility. 6,7 In maintaining a good peripheral perfusion, the choice of anesthetics and other drugs is an important consideration. It is known that both propofol and inhalation agents have a concentration-dependent vasodilatory effect.…”

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

“…If circulatory parameters are kept mostly constant in otherwise healthy patients, then there is no longer any significant difference between propofol (TIVA) and sevoflurane in the intraoperative anemia. There is no unanimous view whether a beta sympatholytic drug (esmolol) is an advantage [144], [169], [170]. The change in anesthesia regarding the balance between hypnosis and analgesia resulted in no substantial benefit [171].…”