Abstract
BackgroundDeliberate 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.MethodsThe 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.ResultsForty 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.ConclusionNitroglycerin-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 registrationThe study was registered at clinicaltrials registry system with trial number: NCT03809065. Registered at 19 January 2019. This study adheres to CONSORT guidelines.
Highlights
Deliberate hypotension is used to provide a bloodless field during functional endoscopic sinus surgery; the impact of controlled hypotension during anesthesia on peripheral tissue perfusion has not been extensively evaluated
Patient characteristics and operative data were comparable between the study groups; with the exception of time to reach target Surgical Field Score (SFS), which was lower in the labetalol group (Table 1)
Results of our study revealed that nitroglycerin-induced deliberate hypotension was associated with more preserved peripheral perfusion index (PPI) compared with labetalol-induced deliberate hypotension
Summary
Deliberate hypotension is used to provide a bloodless field during functional endoscopic sinus surgery; the impact of controlled hypotension during anesthesia on peripheral tissue perfusion has not been extensively evaluated. Monitoring of blood flow in non-vital organs (such as the skin) has been considered to be a good alternative for assessment of the impact of deliberate hypotension on tissue perfusion. We hypothesized that monitoring PPI would be a useful tool for evaluating the safety of deliberate hypotension. Serum lactate is another frequently used marker of global tissue perfusion in the operating room as well as the intensive care unit [3]
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