Effects of intraoperative use of beta-adrenoblockers in endoscopic rhinosinus surgery under general anesthesia

Functional endoscopic sinus surgery (FESS) provides not only optimal access with a sufficient overview of the surgical field, but also allows to preserve with minimal trauma the functionality of the ostiomeatal complex zone, to provide ventilation and drainage through the natural respiratory tract. To perform FESS procedures it is important to minimize bleeding in the surgical area, since even a small amount of blood can deteriorate the endoscopic view.

The aim of the study: to evaluate the effects of beta-blockers as component of general anesthesia in functional endoscopic sinus surgery.

Materials and methods: 110 patients were included in a single-center prospective cohort study. FESS procedures were performed under general anesthesia. 3 groups of patients were intraoperatively isolated: without administration of beta-blockers (BB) (control group, C) (n=40); with intravenous metoprolol (M) (n=35) 1-2 mg each until a heart rate of 50-60 beats /min, but no more than 15 mg; with intravenous esmolol (E) (n=35) with loading dose of 0.5 mg/kg during 1 min., then 0.05 – 0.15 mg/kg/min. The same type of general anesthesia was performed in all groups The intraoperative intensity of bleeding (IB), heart rate (HR bpm), noninvasive systolic (SBP), diastolic (DBP) and mean blood pressure (MBP) (mm Hg.), perfusion index (PI) were assessed. The study points were the 10th, 30th and the 60th minute of the procedure.

Results and discussion: HR in group C at all points of the study was statistically significantly higher compared to group M and E. MBP significantly differed at the 10th minute of the procedure between the groups, at the 30th minute the levels of MBP were the same in all compared groups, and at the 60th minute in the group M recorded high MBP compared to group E. At the 30th and 60th minutes of the procedure, PI was lower in groups M and E compared to group C. The IB was convincingly lower at all points of the study in groups M and E compared to group C and did not differ between groups M and E. In the prognostic model when assessing factors that may affect the development of intraoperative bleeding the fact of the use of BB in groups M and E leads to a decrease IB at all points of the study. An increase in IB is predicted with an increase in HR and SBP at the 10th and 60th minutes of the procedure.

Conclusion: 1. Intraoperative use of beta-blockers in addition to reduction of the heart rate leads to a moderate decrease in mean blood pressure and a decrease in intraoperative bleeding during functional endoscopic sinus surgical procedures under general anesthesia. 2. Metoprolol and esmolol have the same effectiveness for reducing the intensity of bleeding during FESS procedures. 3. The use of esmolol causes a more expressed decrease in heart rate and mean blood pressure compared to metoprolol.

Short summary. The effects of beta-blockers as component of general combined anesthesia in functional endoscopic sinus surgery were studied. It was found out that intraoperative use of beta-blockers in addition to decreasing heart rate leads to a moderate decrease in mean blood pressure and a decrease in intraoperative bleeding. Metoprolol and esmolol are equally effective, but the use of esmolol causes a more significant decrease in heart rate and mean blood pressure compared to metoprolol.

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