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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.
BMC Anesthesiol. 2020 04 17; 20(1):85.BA

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.

Links

PMC Free PDF

Authors+Show Affiliations

Zayed M
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt. marwa.zayed@kasralainy.edu.eg. Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 elsarayah street, Elmanyal, Cairo, 11559, Egypt. marwa.zayed@kasralainy.edu.eg.
Nassar H
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Hasanin A
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Saleh AH
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Hassan P
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Saad D
Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 elsarayah street, Elmanyal, Cairo, 11559, Egypt.
Mahmoud S
Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 elsarayah street, Elmanyal, Cairo, 11559, Egypt.
Abo Bakr G
Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 elsarayah street, Elmanyal, Cairo, 11559, Egypt.
Fouad E
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Saleh N
Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 elsarayah street, Elmanyal, Cairo, 11559, Egypt.
Ismail M
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
El-Hadi H
Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 elsarayah street, Elmanyal, Cairo, 11559, Egypt.

MeSH

AdultAntihypertensive AgentsDouble-Blind MethodEndoscopyFemaleHumansHypotension, ControlledLabetalolLactic AcidMaleNitroglycerinParanasal SinusesPerfusion IndexPilot ProjectsVasodilator AgentsYoung Adult

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

32303182

Clinical Trial Links

Clinical trial which this article describes

Citation

Zayed, Marwa, et al. "Effects of Nitroglycerin Versus Labetalol On Peripheral Perfusion During Deliberate Hypotension for Sinus Endoscopic Surgery: a Randomized, Controlled, Double-blinded Trial." BMC Anesthesiology, vol. 20, no. 1, 2020, p. 85.
Zayed M, Nassar H, Hasanin A, et al. Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial. BMC Anesthesiol. 2020;20(1):85.
Zayed, M., Nassar, H., Hasanin, A., Saleh, A. H., Hassan, P., Saad, D., Mahmoud, S., Abo Bakr, G., Fouad, E., Saleh, N., Ismail, M., & El-Hadi, H. (2020). Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial. BMC Anesthesiology, 20(1), 85. https://doi.org/10.1186/s12871-020-01006-w
Zayed M, et al. Effects of Nitroglycerin Versus Labetalol On Peripheral Perfusion During Deliberate Hypotension for Sinus Endoscopic Surgery: a Randomized, Controlled, Double-blinded Trial. BMC Anesthesiol. 2020 04 17;20(1):85. PubMed PMID: 32303182.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial. AU - Zayed,Marwa, AU - Nassar,Heba, AU - Hasanin,Ahmed, AU - Saleh,Amany H, AU - Hassan,Passaint, AU - Saad,Dalia, AU - Mahmoud,Sahar, AU - Abo Bakr,Ghada, AU - Fouad,Eman, AU - Saleh,Norhan, AU - Ismail,Maha, AU - El-Hadi,Hani, Y1 - 2020/04/17/ PY - 2019/12/19/received PY - 2020/04/12/accepted PY - 2020/4/19/entrez PY - 2020/4/19/pubmed PY - 2021/6/25/medline KW - Deliberate hypotension KW - Labetalol KW - Lactate KW - Nitroglycerin KW - Peripheral perfusion SP - 85 EP - 85 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 20 IS - 1 N2 - 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. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/32303182/Effects_of_nitroglycerin_versus_labetalol_on_peripheral_perfusion_during_deliberate_hypotension_for_sinus_endoscopic_surgery:_a_randomized_controlled_double_blinded_trial_ DB - PRIME DP - Unbound Medicine ER -