Comparison of Nitroglycerine- and prostaglandin E1 -induced controlled hypotension for functional endoscopic sinus surgery [FESS]

ABSTRACT

Induced hypotension is often used in surgery to reduce blood loss and to provide a relatively bloodless surgical field to facilitate surgery and to reduce operative time. The purpose of this study was to compare the intraoperative bleeding and quality of the surgical field for FESS, using controlled hypotension induced with either nitroglycerine or prostaglandin E1.Patients and methods: Thirty patients [ASA I - II] scheduled for FESS were enrolled in the study. Patients were randomly allocated into three groups where normotensive group [C] received saline infusion, nitroglycerine hypotensive group [NTG] received NTG infusion at a rate of [0.5-5 micro g/kg/min] and, prostaglandin hypotensive group [PGEI] received PGE1 infusion at a rate of [0.04-0.08 micro g/kg/min]. The same surgeon used a categorical scale score[0-S] to assess surgical field condition. Heart rate and invasive mean arterial blood pressure, peripheral oxygen saturation and end- tidal carbon dioxide were monitored intraoperatively. there was statistically significant decrease of blood loss in both PGE1 and NTG groups as compared to group C. Moreover there was statistically significant decrease of blood loss in PGE1 group as compared to NTG group. Intraoperative heart rate of NTG group displayed significant increased when compared to basal value of the same group, C group and PGE1 groups values. Both PGE1 and NTG groups showed significantly reduced MAP than C group except one value in NTG group where it significantly increased at 30 min, Induced hypotension with PGE1 infusion is interesting in providing consistent and sustained controlled hypotension with hemodynamic stability as well as it is effective in providing dry surgical field during FESS under general anaesthesia when compared with NTG