The efficacy of Labetalol versus Nitroglycerin for induction of controlled hypotension during sinus endoscopic surgery. A prospective, double-blind and randomized study

Elshmaa, Nagat S.; Ezz, Hoda Alsaid Ahmed; Younes, Ahmed

doi:10.1016/j.jclinane.2017.03.003

Cited by 29 publications

(28 citation statements)

References 13 publications

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“…These data indicated that FESS under HA is safe to patients and satisfactory to surgeons and thus improved surgical outcome with subsequent improvement of PO clinical and radiological scoring. These findings coincided with previous studies evaluated HA during FESS using magnesium sulfate versus lidocaine [13] , clonidine [12,[26][27][28] , dexmedetomedine [28,29] and labetalol versus nitroglycerin [30] .…”

Section: Resultssupporting

confidence: 92%

Surgical Field Visibility during Functional Endoscopic Sinus Surgery: esmolol-induced hypotensive anesthesia versus hypotensive total intravenous anesthesia

Ahmed

Elsayed

Sarhan³

et al. 2019

International Journal of Medical Arts

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Background: Functional endoscopic sinus surgery is widely practiced during daily otorhinolaryngology practice. It usually done under low blood pressure. However, the ideal hypotensive drug or technique is yet not well established. Aim of the work: To evaluate outcome of functional endoscopic sinus surgery under esmolol-induced hypotensive anesthesia [EHA] versus hypotensive total intravenous anesthesia [H-TIVA]. Patients & Methods: 72 patients were randomly divided into two groups; Group A: H-TIVA and Group B [EHA]. After induction of anesthesia, remifentanil/ propofol and esmolol infusions were adjusted to maintain mean arterial pressure at 60-70 mmHg. After completion of surgical procedure, esmolol infusion was stopped, while remifentanil/propofol infusions were adjusted to allow restoration of blood pressure. Operative field bleeding and visibility were graded using Fromme scale. Primary outcome is the efficacy of EHA to minimize intraoperative bleeding to an extent that allows satisfactory completion of surgery. Results: Esmolol bolus significantly attenuated pressor reflexes to induction and intubation than induction by remifentanil. Intraoperative [IO] heart rate and MAP measures were significantly lower with EHA. At 10-minures after infusion stoppage, patients of group B still had significantly lower HR and MAP, while at 10-min later, the difference was nonsignificant. HA minimized IO blood loss down to no to slight bleeding in 16.7% and 55.5% of studied patients and improved field visibility to satisfactory-to-good levels in 51.4% and 43.1% of surgeries, respectively. Moreover, EHA provided better field visibility, so allowed significant reduction of operative time than with TIVA. Conclusion: Hypotensive anesthesia is safe and appropriate modality for FESS and improves surgical and clinical outcome. Both esmolol and remifentanil provided satisfactory results. Esmolol is superior to remifentanil.

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Section: Resultssupporting

confidence: 92%

Surgical Field Visibility during Functional Endoscopic Sinus Surgery: esmolol-induced hypotensive anesthesia versus hypotensive total intravenous anesthesia

Ahmed

Elsayed

Sarhan³

et al. 2019

International Journal of Medical Arts

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“…In our patients, we found that the nitroglycerin group exhibited a higher heart rate in some intraoperative periods, while heart rate was comparable between the groups in most of the other readings. El-Shamma et al and Hadavi et al reported that nitroglycerin infusion was associated with more prominent reflex tachycardia compared with labetalol [6,8]. The difference between our results and those reported by El-Shamma et al and Hadavi et al may be due to the higher dose of nitroglycerin or the larger sample sizes of their studies [6,8].…”

Section: Discussioncontrasting

confidence: 70%

“…Nitroglycerin and labetalol were previously compared in achieving deliberate hypotension [6][7][8][9]. However, the results of previous studies did not totally favor one drug over the other.…”

Section: Discussionmentioning

confidence: 99%

“…Labetalol combines an α1 blocking effect and beta-adrenergic blocking activity to reduce systemic vascular resistance, with little effect on cardiac output [5,6]. Both drugs were previously compared during controlled hypotension with regard to surgical field quality and blood loss [6][7][8][9]. To date, however, no study has compared the effects of both drugs on peripheral perfusion.…”

Section: Introductionmentioning

confidence: 99%

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Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial

et al. 2020

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Background: Deliberate hypotension is used to provide a bloodless field during functional endoscopic sinus surgery; however, the impact of controlled hypotension during anesthesia on peripheral tissue perfusion has not been extensively evaluated. The aim of this study was to compare the impact of nitroglycerin-versus labetalolinduced hypotension on peripheral perfusion. Methods: The present randomized, double-blinded, controlled trial included adult patients undergoing endoscopic sinus surgery. Patients were allocated to one of two groups according to the drug received for induction of deliberate hypotension: nitroglycerin (n = 20) or labetalol (n = 20). Mean arterial pressure was maintained at 55-65 mmHg in both groups. Both study groups were compared according to pulse oximeter-derived peripheral perfusion index (primary outcome), serum lactate level, mean arterial pressure, heart rate, surgical field score, and intraoperative blood loss. Results: Forty patients were included in the final analysis. The nitroglycerin group exhibited a higher peripheral perfusion index at nearly all records (p < 0.0001) and lower postoperative serum lactate levels (1.3 ± 0.2 mmol/L vs. 1.7 ± 0.4 mmol/L; p = 0.001) than the labetalol group. The peripheral perfusion index was higher in the nitroglycerin group than at baseline at most intraoperative readings. The median surgical field score was modestly lower in the labetalol group than in the nitroglycerin group in the first 20 min (2 [interquartile range (IQR) 2-2.5] versus 1.5 [IQR 1-2]; p = 0.001). Both groups demonstrated comparable and acceptable surgical field scores in all subsequent readings. Conclusion: Nitroglycerin-induced deliberate hypotension was accompanied by higher peripheral perfusion index and lower serum lactate levels than labetalol-induced deliberate hypotension during sinus endoscopic surgery.

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“…In line with the use of labetalol infusion for maintenance of low IO blood pressure, Jeong et al (28) reported a significant reduction of mean arterial pressure of patients received both sevoflurane and labetalol compared to those received sevoflurane only. Moreover, Hadavi et al (29) and El-Shmaa et al (30) assured the effectiveness and safety of both labetalol and nitroglycerine infusions for controlled hypotension during rhinoplastic (29) and sinus endoscopic surgery (30). In support of efficacy of I0 labetalol, El-Shmaa et al (30) documented that labetalol infusion is more beneficial for providing mild hypotension with optimum operative condition, decreased surgical bleeding and less tachycardia during the surgery.…”

Section: Discussionmentioning

confidence: 99%

Labetalol Hypotensive Anesthetic Protocol paves the way to Safe Open Abdominal Myomectomy: Comparative study versus Tourniquet Hemostasis

Ragab

Hagras

Salem

et al. 2018

The Egypt. J. of Fert.y of Steri.

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The efficacy of Labetalol versus Nitroglycerin for induction of controlled hypotension during sinus endoscopic surgery. A prospective, double-blind and randomized study

Cited by 29 publications

References 13 publications

Surgical Field Visibility during Functional Endoscopic Sinus Surgery: esmolol-induced hypotensive anesthesia versus hypotensive total intravenous anesthesia

Surgical Field Visibility during Functional Endoscopic Sinus Surgery: esmolol-induced hypotensive anesthesia versus hypotensive total intravenous anesthesia

Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial

Labetalol Hypotensive Anesthetic Protocol paves the way to Safe Open Abdominal Myomectomy: Comparative study versus Tourniquet Hemostasis

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