Skip to main content

Advertisement

SpringerLink
Log in

Does preoperative administration of hypotensive agents affect the quality of the surgical field during endoscopic sinus surgery? A triple-blind randomized controlled trial

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Endoscopic sinus surgery (ESS) is a surgical procedure widely used in the treatment of various sinonasal conditions. Excessive bleeding during ESS leads to potentially major complications. The primary aim of this trial was to explore any different effects of bisoprolol and nifedipine on the intraoperative surgical field. In addition, the correlations regarding surgical field state, total blood loss (TBL), mean arterial pressure (MAP), and heart rate (HR) were also examined.

Methods

A prospective, triple-blinded, randomized, placebo-controlled trial was conducted, including 72 patients between 18 and 65 years of age who underwent ESS. As an indicator of the worst state of the intraoperative surgical field, the Boezaart scale score was used, as evaluated by two surgeons. Appropriate statistical analysis was conducted to explore score comparisons across groups and correlations between vital signs, bleeding, and the operative field state.

Results

No statistically significant difference was found among different intervention groups regarding the worst state of the surgical field (p = 0.367 > 0.05). The Boezaart scale score was positively correlated with TBL (rxy = 0.619, p = 0.000 < 0.001) and MAP (rxy = 0.259, p = 0.028 < 0.05). Furthermore, MAP was positively correlated with HR (rs = 0.254, p = 0.32 < 0.05).

Conclusion

Our study demonstrates that preoperative administration of bisoprolol and nifedipine does not affect the worst state of the operative field. However, vital signs seem to either directly or indirectly affect bleeding and operative field state, and agents affecting them are worth exploring further.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Wormald PJ, van Renen G, Perks J, Jones JA, Langton-Hewer CD (2005) The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol 19:514–520

    Article  PubMed  Google Scholar 

  2. Ha TN, van Renen RG, Ludbrook GL, Valentine R, Ou J, Wormald PJ (2014) The relationship between hypotension, cerebral flow, and the surgical field during endoscopic sinus surgery. Laryngoscope 124:2224–2230. https://doi.org/10.1002/lary.24664

    Article  PubMed  Google Scholar 

  3. Drozdowski A, Sieskiewicz A, Siemiatkowski A (2011) Reduction of intraoperative bleeding during functional endoscopic sinus surgery. Anestezjol Intens Ter 43:45–50

    PubMed  Google Scholar 

  4. Stankiewicz JA (1989) Complications in endoscopic intranasal ethmoidectomy: an update. Laryngoscope 99:686–690. https://doi.org/10.1288/00005537-198907000-00004

    Article  CAS  PubMed  Google Scholar 

  5. Maniglia AJ (1991) Fatal and other major complications of endoscopic sinus surgery. Laryngoscope 101:349–354. https://doi.org/10.1002/lary.1991.101.4.349

    Article  CAS  PubMed  Google Scholar 

  6. Lund VJ, MacKay IS (1994) Outcome assessment of endoscopic sinus surgery. J R Soc Med 87:70–72. https://doi.org/10.1177/014107689408700204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Nair S, Collins M, Hung P, Rees G, Close D, Wormald PJ (2004) The effect of beta-blocker premedication on the surgical field during endoscopic sinus surgery. Laryngoscope 114:1042–1046. https://doi.org/10.1097/00005537-200406000-00016

    Article  CAS  PubMed  Google Scholar 

  8. Cincikas D, Ivaskevicius J (2003) Application of controlled arterial hypotension in endoscopic rhinosurgery. Medicina (Kaunas) 39:852–859

    PubMed  Google Scholar 

  9. Brunner JP, Levy JM, Ada ML, Tipirneni KE, Barham HP, Oakley GM et al (2018) Total intravenous anesthesia improves intraoperative visualization during surgery for high-grade chronic rhinosinusitis: a double-blind randomized controlled trial. Int Forum Allergy Rhinol 8:1114–1122. https://doi.org/10.1002/alr.22173

    Article  PubMed  PubMed Central  Google Scholar 

  10. Olson G, Citardi MJ (2000) Image-guided functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 123:188–194. https://doi.org/10.1067/mhn.2000.107453

    Article  CAS  PubMed  Google Scholar 

  11. El-Shmaa NS, Ezz HAA, Younes A (2017) The efficacy of Labetalol versus Nitroglycerin for induction of controlled hypotension during sinus endoscopic surgery. A prospective, double-blind and randomized study. J Clin Anesth 39:154–158. https://doi.org/10.1016/j.jclinane.2017.03.003

    Article  CAS  PubMed  Google Scholar 

  12. Ankichetty SP, Ponniah M, Cherian V, Thomas S, Kumar K, Jeslin L et al (2011) Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol 27:328–332. https://doi.org/10.4103/0970-9185.83675

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Gollapudy S, Gashkoff DA, Poetker DM, Loehrl TA, Riess ML (2020) Surgical field visualization during functional endoscopic sinus surgery: comparison of propofol- vs desflurane-based anesthesia. Otolaryngol Head Neck Surg 163:835–842. https://doi.org/10.1177/0194599820921863

    Article  PubMed  PubMed Central  Google Scholar 

  14. Boezaart AP, van der Merwe J, Coetzee A (1995) Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 42:373–376. https://doi.org/10.1007/BF03015479

    Article  CAS  PubMed  Google Scholar 

  15. Boezaart AP, van der Merwe J, Coetzee AR (2001) Re: Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. J Clin Anesth 13:319–320. https://doi.org/10.1016/s0952-8180(01)00247-1

    Article  CAS  PubMed  Google Scholar 

  16. Jacobi KE, Böhm BE, Rickauer AJ, Jacobi C, Hemmerling TM (2000) Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. J Clin Anesth 12:202–207. https://doi.org/10.1016/s0952-8180(00)00145-8

    Article  CAS  PubMed  Google Scholar 

  17. Toivonen J, Virtanen H, Kaukinen S (1989) Deliberate hypotension induced by labetalol with halothane, enflurane or isoflurane for middle-ear surgery. Acta Anaesthesiol Scand 33:283–289. https://doi.org/10.1111/j.1399-6576.1989.tb02909.x

    Article  CAS  PubMed  Google Scholar 

  18. Escamilla Y, Cardesín A, Samara L, López S, Izquierdo A, Fradera M et al (2019) Randomized clinical trial to compare the efficacy to improve the quality of surgical field of hypotensive anesthesia with clonidine or dexmedetomidine during functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol 276:3095–3104. https://doi.org/10.1007/s00405-019-05575-6

    Article  CAS  PubMed  Google Scholar 

  19. Bafna U, Sharma P, Singhal RK, Gurjar SS, Bhargava SK (2021) Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery: a randomised, double-blind interventional study. Indian J Anaesth 65:579–585. https://doi.org/10.4103/ija.IJA_57_21

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bairy L, Vanderstichelen M, Jamart J, Collard E (2017) Clonidine or remifentanil for adequate surgical conditions in patients undergoing endoscopic sinus surgery: a randomized study. PeerJ 5:e3370. https://doi.org/10.7717/peerj.3370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Gupta KK, Kumari V, Kaur S, Singh A (2022) Comparative evaluation of propofol versus dexmedetomidine infusion for hypotensive anesthesia during functional endoscopic sinus surgery: a prospective randomized trial. Anesth Pain Med (Seoul) 17:271–279. https://doi.org/10.17085/apm.21118

    Article  PubMed  Google Scholar 

  22. Mahajan L, Singh AP, Chawla S, Gill S (2020) Premedication for induced hypotension in functional endoscopic sinus surgeries: intravenous dexmedetomidine infusion vs oral metoprolol vs placebo: a comparative study. Anesth Essays Res 14:578–583. https://doi.org/10.4103/aer.AER_19_21

    Article  PubMed  Google Scholar 

  23. Sahu BP, Nayak LK, Mohapatra PS, Mishra K (2021) Induced hypotension in functional endoscopic sinus surgery: a comparative study of dexmedetomidine and esmolol. Cureus 13:e15069. https://doi.org/10.7759/cureus.15069

    Article  PubMed  PubMed Central  Google Scholar 

  24. Srivastava U, Dupargude AB, Kumar D, Joshi K, Gupta A (2013) Controlled hypotension for functional endoscopic sinus surgery: comparison of esmolol and nitroglycerine. Indian J Otolaryngol Head Neck Surg 65:440–444. https://doi.org/10.1007/s12070-013-0655-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Sujay NS, Kumar S, Vijay T (2021) To compare the efficacy of dexmedetomidine versus labetalol in providing controlled hypotension in functional endoscopic sinus surgery. Anesth Pain Med 11:e108915. https://doi.org/10.5812/aapm.108915

    Article  Google Scholar 

  26. Zayed M, Nassar H, Hasanin A, Saleh AH, Hassan P, Saad D et al (2020) Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial. BMC Anesthesiol 20:85. https://doi.org/10.1186/s12871-020-01006-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Liu B, Zhang R, Zhang A, Wang G, Xu J, Zhang Y et al (2023) Effectiveness and safety of four different beta-blockers in patients with chronic heart failure. MedComm 4:e199. https://doi.org/10.1002/mco2.199

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Singh J, Elton A, Kwa M (2023) Comparison of various calcium antagonist on vasospastic angina: a systematic review. Open Heart 10:e002179. https://doi.org/10.1136/openhrt-2022-002179

    Article  PubMed  PubMed Central  Google Scholar 

  29. Enlund MG, Ahlstedt BL, Andersson LG, Krekmanov LI (1997) Induced hypotension may influence blood loss in orthognathic surgery, but it is not crucial. Scand J Plast Reconstr Surg Hand Surg 31:311–317. https://doi.org/10.3109/02844319709008977

    Article  CAS  PubMed  Google Scholar 

  30. Fromme GA, MacKenzie RA, Gould AB Jr, Lund BA, Offord KP (1986) Controlled hypotension for orthognathic surgery. Anesth Analg 65:683–686

    Article  CAS  PubMed  Google Scholar 

  31. Sivarajan M, Amory DW, Everett GB, Buffington C (1980) Blood pressure, not cardiac output, determines blood loss during induced hypotension. Anesth Analg 59:203–206

    Article  CAS  PubMed  Google Scholar 

  32. Sartcaoglu F, Celiker V, Basgul E, Yapakci O, Aypar U (2005) The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery. Eur J Anaesthesiol 22:157–159. https://doi.org/10.1017/s0265021505230284

    Article  CAS  PubMed  Google Scholar 

  33. Sajedi P, Rahimian A, Khalili G (2016) Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy. J Res Pharm Pract 5:264–271. https://doi.org/10.4103/2279-042x.192463

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Schindler I, Andel H, Leber J, Kimla T (1994) Moderate induced hypotension provides satisfactory operating conditions in maxillofacial surgery. Acta Anaesthesiol Scand 38:384–387. https://doi.org/10.1111/j.1399-6576.1994.tb03912.x

    Article  CAS  PubMed  Google Scholar 

  35. Ali Algadiem E, Aleisa AA, Alsubaie HI, Buhlaiqah NR, Algadeeb JB, Alsneini HA (2016) Blood loss estimation using gauze visual analogue. Trauma Mon 21:e34131. https://doi.org/10.5812/traumamon.34131

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece

    Antonios Skalias, Paraskevi Karamitsou, Vaia Tsapara, Alexandros Poutoglidis & Spyridon Gougousis

  2. Department of Anaesthesia and Critical Care, AHEPA Hospital, Thessaloniki, Greece

    Giakoumis Mitos

  3. Department of Anaesthesia, Papageorgiou Hospital, Thessaloniki, Greece

    Eirini Zarzava

Authors
  1. Antonios Skalias
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paraskevi Karamitsou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giakoumis Mitos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eirini Zarzava
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vaia Tsapara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexandros Poutoglidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Spyridon Gougousis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonios Skalias.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Research involving human participants and/or animals

The procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board of the Hospital (IRB) also approved the study with review number ‘7th/10.04.2019’.

Informed consent

Written informed consent for participation in the trial was provided by all patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Skalias, A., Karamitsou, P., Mitos, G. et al. Does preoperative administration of hypotensive agents affect the quality of the surgical field during endoscopic sinus surgery? A triple-blind randomized controlled trial. Eur Arch Otorhinolaryngol 280, 4485–4490 (2023). https://doi.org/10.1007/s00405-023-08017-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-023-08017-6

Keywords

Search

Navigation