Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial
Abstract 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 impa...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12871-020-01006-w |
| _version_ | 1818264590465630208 |
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| author | Marwa Zayed Heba Nassar Ahmed Hasanin Amany H. Saleh Passaint Hassan Dalia Saad Sahar Mahmoud Ghada Abo Bakr Eman Fouad Norhan Saleh Maha Ismail Hani El-Hadi |
| author_facet | Marwa Zayed Heba Nassar Ahmed Hasanin Amany H. Saleh Passaint Hassan Dalia Saad Sahar Mahmoud Ghada Abo Bakr Eman Fouad Norhan Saleh Maha Ismail Hani El-Hadi |
| author_sort | Marwa Zayed |
| collection | DOAJ |
| description | Abstract 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 labetalol-induced 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. Trial registration The study was registered at clinicaltrials registry system with trial number: NCT03809065 . Registered at 19 January 2019. This study adheres to CONSORT guidelines. |
| first_indexed | 2024-12-12T19:37:20Z |
| format | Article |
| id | doaj.art-4ff62f7be02841a88948ed9e1fb286e5 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-12T19:37:20Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-4ff62f7be02841a88948ed9e1fb286e52022-12-22T00:14:17ZengBMCBMC Anesthesiology1471-22532020-04-012011910.1186/s12871-020-01006-wEffects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trialMarwa Zayed0Heba Nassar1Ahmed Hasanin2Amany H. Saleh3Passaint Hassan4Dalia Saad5Sahar Mahmoud6Ghada Abo Bakr7Eman Fouad8Norhan Saleh9Maha Ismail10Hani El-Hadi11Department of Anesthesia and Critical Care Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Cairo UniversityDepartment of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo UniversityAbstract 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 labetalol-induced 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. Trial registration The study was registered at clinicaltrials registry system with trial number: NCT03809065 . Registered at 19 January 2019. This study adheres to CONSORT guidelines.http://link.springer.com/article/10.1186/s12871-020-01006-wDeliberate hypotensionNitroglycerinLabetalolPeripheral perfusionLactate |
| spellingShingle | Marwa Zayed Heba Nassar Ahmed Hasanin Amany H. Saleh Passaint Hassan Dalia Saad Sahar Mahmoud Ghada Abo Bakr Eman Fouad Norhan Saleh Maha Ismail Hani El-Hadi Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial BMC Anesthesiology Deliberate hypotension Nitroglycerin Labetalol Peripheral perfusion Lactate |
| title | Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial |
| title_full | Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial |
| title_fullStr | Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial |
| title_full_unstemmed | Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial |
| title_short | Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial |
| title_sort | effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery a randomized controlled double blinded trial |
| topic | Deliberate hypotension Nitroglycerin Labetalol Peripheral perfusion Lactate |
| url | http://link.springer.com/article/10.1186/s12871-020-01006-w |
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