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

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.

Keywords: Deliberate hypotension; Labetalol; Lactate; Nitroglycerin; Peripheral perfusion.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Flow diagram showing patients’ recruitment

Fig. 2

Mean arterial pressure at time points between groups. Markers are means, error bars are standard deviations. Ext: extubation, PACU: post-anesthesia care unit. * denotes significance between both groups., † denotes significance compared to the baseline reading within nitroglycerin group, ‡ denotes significance compared to the baseline reading within labetalol group

Fig. 3

Heart rate at time points between groups. Markers are means, error bars are standard deviations. Ext: extubation, PACU: post-anesthesia care unit. * denotes significance between both groups, † denotes significance compared to the baseline reading within nitroglycerin group, ‡ denotes significance compared to the baseline reading within labetalol group

Fig. 4

Peripheral perfusion index. Markers are means, error bars are standard deviations. * denotes significance between both groups., † denotes significance compared to the baseline reading within nitroglycerin group, ‡ denotes significance compared to the baseline reading within labetalol group