Department of Anesthesia & Surgical ICU, Faculty of Medicine, Tanta University, Egypt.
Department of ENT, Faculty of Medicine, Tanta University, Egypt.
J Clin Anesth. 2017 Jun;39:154-158. doi: 10.1016/j.jclinane.2017.03.003. Epub 2017 Apr 10.
To assess the efficacy of labetalol versus nitroglycerin for induction of controlled hypotension during sinus endoscopic surgery.
A prospective, double-blind and randomized study.
Carried out in operating room in university hospital.
60 patients of both sexes, American Society of Anesthesiologists (ASA) physical status I and II, age range from 20 to 60years; scheduled for elective sinus endoscopic surgery under general anesthesia (GA).
Patients were divided into two groups (30 each). NTG group received nitroglycerin infusion at a dose of 2-5μg/kg/min, LAB group received labetalol infusion at a dose of 0.5-2mg/min.
Surgical condition was assessed by surgeon using average category scale (ACS) of 0-5, a value of 2-3 being ideal. In both groups mean arterial blood pressure (MAP) was gradually reduced till the ideal ACS for assessment of surgical condition, the target of ACS was 2-3 or lower.
Both studied drugs achieved desired hypotension and improved visualization of surgical field by decreasing bleeding in the surgical site, but ideal surgical conditions were created at mild hypotension (MAP 70-75) in LAB group while same conditions were created at MAP of 65-69mmHg in NTG group. Mean heart rate (HR) was significantly higher in NTG group as compared to LAB group. Blood loss decreased significantly in LAB group.
Both labetalol and NTG are effective and safe drugs for induction of controlled hypotension during sinus endoscopic surgery. While, labetalol was better as it offered optimum operative condition with mild decrease in blood pressure, decreased surgical bleeding and less tachycardia during the surgery.
评估拉贝洛尔与硝酸甘油在鼻窦内窥镜手术中控制性降压的疗效。
前瞻性、双盲、随机研究。
在大学医院的手术室进行。
60 名男女患者，美国麻醉医师协会（ASA）身体状况 I 和 II 级，年龄 20 至 60 岁；在全身麻醉（GA）下择期行鼻窦内窥镜手术。
患者分为两组（每组 30 人）。NTG 组给予硝酸甘油输注，剂量为 2-5μg/kg/min；LAB 组给予拉贝洛尔输注，剂量为 0.5-2mg/min。
外科医生使用平均类别评分（ACS）0-5 评估手术条件，2-3 分为理想。在两组中，平均动脉血压（MAP）逐渐降低，直到评估手术条件的理想 ACS，目标 ACS 为 2-3 或更低。
两种研究药物均通过减少手术部位出血实现了所需的低血压和改善了手术视野的可视化，但在 LAB 组中，在 MAP 为 70-75mmHg 的轻度低血压下可创造理想的手术条件，而在 NTG 组中，在 MAP 为 65-69mmHg 下可创造相同的条件。与 LAB 组相比，NTG 组的平均心率（HR）显著升高。LAB 组的出血量明显减少。
拉贝洛尔和硝酸甘油都是鼻窦内窥镜手术中诱导控制性降压的有效且安全的药物。然而，拉贝洛尔更好，因为它在血压轻度下降的情况下提供了最佳的手术条件，减少了手术出血和术中心动过速。
