Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial.
Adult
Antihypertensive Agents
/ administration & dosage
Double-Blind Method
Endoscopy
/ methods
Female
Humans
Hypotension, Controlled
/ methods
Labetalol
/ administration & dosage
Lactic Acid
/ blood
Male
Nitroglycerin
/ administration & dosage
Paranasal Sinuses
/ surgery
Perfusion Index
Pilot Projects
Vasodilator Agents
/ administration & dosage
Young Adult
Deliberate hypotension
Labetalol
Lactate
Nitroglycerin
Peripheral perfusion
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
17 04 2020
17 04 2020
Historique:
received:
19
12
2019
accepted:
12
04
2020
entrez:
19
4
2020
pubmed:
19
4
2020
medline:
25
6
2021
Statut:
epublish
Résumé
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. 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. 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. 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. The study was registered at clinicaltrials registry system with trial number: NCT03809065. Registered at 19 January 2019. This study adheres to CONSORT guidelines.
Sections du résumé
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.
Identifiants
pubmed: 32303182
doi: 10.1186/s12871-020-01006-w
pii: 10.1186/s12871-020-01006-w
pmc: PMC7164266
doi:
Substances chimiques
Antihypertensive Agents
0
Vasodilator Agents
0
Lactic Acid
33X04XA5AT
Nitroglycerin
G59M7S0WS3
Labetalol
R5H8897N95
Banques de données
ClinicalTrials.gov
['NCT03809065']
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
85Références
Lancet. 2002 Nov 2;360(9343):1395-6
pubmed: 12423989
World J Plast Surg. 2015 Jan;4(1):60-5
pubmed: 25606478
J Clin Anesth. 2017 Jun;39:154-158
pubmed: 28494895
Eur Heart J. 1988 Jan;9 Suppl A:201-3
pubmed: 3137067
Indian J Pediatr. 2019 Oct;86(10):903-908
pubmed: 31197646
Crit Care. 2014 Jun 19;18(3):R126
pubmed: 24946777
J Clin Monit Comput. 2016 Oct;30(5):655-60
pubmed: 26358703
Shock. 2017 Mar;47(3):269-275
pubmed: 27787407
J Clin Monit Comput. 2017 Oct;31(5):961-965
pubmed: 27665572
J Oral Maxillofac Surg. 2008 Oct;66(10):2104-9
pubmed: 18848109
Br J Anaesth. 2017 Aug 1;119(2):276-280
pubmed: 28854539
J Orthop Surg Res. 2019 Dec 2;14(1):409
pubmed: 31791362
Shock. 2015 Dec;44(6):554-9
pubmed: 26529657
Anesth Pain Med. 2017 Oct 25;7(5):e13677
pubmed: 29696111
J Intensive Care. 2017 Mar 14;5:24
pubmed: 28331621
J Clin Monit Comput. 2020 Feb 8;:
pubmed: 32036499
Br J Clin Pharmacol. 1979 Apr;8 Suppl 2:89S-244S
pubmed: 26635175
J Clin Monit Comput. 2019 Nov 9;:
pubmed: 31705432
Crit Care. 2019 Jan 18;23(1):19
pubmed: 30658663
Ann Intensive Care. 2019 Mar 13;9(1):37
pubmed: 30868286
BMC Anesthesiol. 2018 Aug 17;18(1):111
pubmed: 30115011
Anesth Analg. 1986 Jun;65(6):683-6
pubmed: 3706806