Comparing Labetalol and Nitroglycerine on Inducing Controlled Hypotension and Intraoperative Blood Loss in Rhinoplasty: A Single-Blinded Clinical Trial

Ghodraty, Mohammad Reza; Khatibi, Ali; Rokhtabnak, Faranak; Maleki, Mojtaba; Parsa, Fatemeh

doi:10.5812/aapm.13677

Cited by 19 publications

(10 citation statements)

References 15 publications

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“…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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Surgery is an important treatment for trauma patients. Appropriate inhibition of the intraoperative stress response is critical for patients undergoing surgeries . Remifentanil has been confirmed to have excellent antioxidative properties, as well as to inhibit the production of inflammatory factors and alleviate the damage of tissue and organ reperfusion injury …”

Section: Discussionmentioning

confidence: 99%

Remifentanil inhibits the traumatic stress response in emergent trauma surgery

Ouyang

Ren

Liu

et al. 2019

Clinical Laboratory Analysis

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ObjectiveThe aim of this study was to explore whether remifentanil could inhibit the stress response in emergent trauma surgery more effectively than sufentanil.Patients and methodsSixty trauma patients for emergent surgery were randomly divided into remifentanil group (R group, n = 30) or sufentanil group (S group, n = 30). The patients in the R group were continuously intravenously infused with remifentanil, while those in the S group were administrated with sufentanil. The plasma contents of cortisol (COR), epinephrine (E), norepinephrine (NE), and blood glucose were measured before anesthesia induction (T1), 5 minutes after intratracheal intubation (T2) and 5 minutes (T3), 30 minutes (T4), and 1 hour (T5) after surgery, respectively. The blood pressure (BP) and the heart rate (HR) at these time points were recorded as well.ResultsThe results showed that the patients in the R group had more stable hemodynamics during the surgery and had a significantly lower HR at T2‐T5 than those in the S group. The plasma levels of norepinephrine at time points T3‐T5 and levels of cortisol at T4‐T5 in the R group were significantly lower than those in the S group (P < 0.05).ConclusionsThe results in the present study indicated that remifentanil could inhibit the stress response in emergent trauma surgery patients more effectively than sufentanil.

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“…Ghodraty M et al compared Labetalol and Nitroglycerine on Inducing Controlled Hypotension and Intraoperative Blood Loss in Rhinoplasty [11]. Results were based on the study findings, systolic (P < 0.001), diastolic (P = 0.002), and the mean arterial blood pressures (P < 0.001) were significantly lower in the nitroglycerine group.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Phentolamine and Nitroglycerin for Controlled Hypotension during Functional Endoscopic Sinus Surgery

2019

JAPM

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Background: Intraoperative bleeding is one of the most common complications in Functional endoscopic sinus surgery. Controlled hypotension is a method to minimize surgical blood loss and enhance the operative field visibility. The objective of this study was to compare the efficacy of controlled hypotensive anesthesia with intravenous infusion of phentolamine versus nitroglycerin as regarding intraoperative blood loss and hemodynamic stability. Methods: This current randomized study enrolled 30 patients candidate for Functional endoscopic sinus surgery at Beni-suef university hospital, in 2 equal groups receiving either 0.5 to 10 μg/kg/minute nitroglycerin or 0.1 to 2 mg/minute phentolamine to achieve a mean arterial blood pressure (MAP) of about 50 to 65 mmHg. Mean arterial blood pressure, amount of blood loss and the quality of surgical field using the 0-5 point bleeding scale were recorded. Results: Based on the current study findings, the two drugs produced the desired hypotension on the same time point; there were no significant differences between the study groups regarding the volume of bleeding and operative field visibility. Conclusions: Nitroglycerin and Phentolamine are safe, efficient and might be advisable option for deliberate hypotensive anesthesia throughout Functional endoscopic sinus surgery. Phentolamine can be a good alternative to Nitroglycerin in reduction of MAP during this procedure.

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Comparing Labetalol and Nitroglycerine on Inducing Controlled Hypotension and Intraoperative Blood Loss in Rhinoplasty: A Single-Blinded Clinical Trial

Cited by 19 publications

References 15 publications

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

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

Remifentanil inhibits the traumatic stress response in emergent trauma surgery

Comparison between Phentolamine and Nitroglycerin for Controlled Hypotension during Functional Endoscopic Sinus Surgery

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