Comparison of Labetalol and Nitroglycerine on Intraoperative Bleeding in Patients Who Underwent Dacryocystorhinostomy


The bleeding during dacryocystorhinostomy (DCR) surgery is one of the main complications that led to the surgeon’s dissatisfaction and increased the duration of the operation. The current study aimed at comparing the effects of labetalol and nitroglycerine (TNG) on blood loss and the surgeon’s satisfaction during DCR. The current prospective and randomized study enrolled 60 patients candidate for DCR under local anesthesia and sedation and divided into two groups. When the surgeon dissatisfied with bleeding during the operation, patients in the labetalol group received labetalol infusion at a rate of 0.5-2 mg/kg and compared with the subjects in the TNG group that received TNG infusion at a rate of 0.1 µg/kg/min. Additionally, the surgical condition was assessed by the surgeon using the average category scale (ACS) and surgeon’s satisfaction by a scoring system. The average bleeding in the labetalol group was 140.5±24.5 ml versus 170.4±24.6 ml in the TNG group, respectively (P=0.001). The average category scale for the labetalol group was better than the TNG group during all the time of operation. The surgeon satisfaction score during the operation was more in the labetalol group (3.4 in the labetalol group versus 2.8 in the TNG group, respectively). Labetalol was better than TNG for controlling bleeding during DCR procedure because of decreasing surgical blood loss and optimum operative condition. 

1. Sajedi P, Rahimian A, Khalili G. Comparative evaluation between two methods of induced hypotensionwith infusion of remifentanil and labetalol during sinus endoscopy. J Res Pharm Pract 2016;5:264-71.
2. Van Aken H, Miller D. Delibrate hypotension. In: Miller RD, eds. Anesthesia. New York, USA: Churchill Livingstone Inc, 2000:1470-90.
3. Tirelli G, Bigarini S, RussoloM, Lucangelo U, Gullo A. Total intravenous anaesthesia in endoscopic sinus surgery. Acta Otorhinolaryngol Ital 2004;24:137-44.
4. Degoute CS. Controlled hypotension: a guide to drug choice. Drugs 2007;67:1053-76.
5. Stankiewicz JA. Complications of endoscopic sinus surgery. Otolaryngol Clin N Am 1989;22:749-58.
6. Rodrigo C. Induced hypotension during anesthesia with special reference to orthognathic surgery. Anesth Prog 1995;42:41–58.
7. Babita Singh B, Saiyed A, Meena R, Verma I, Vyas KC. A comparative study of labetalol and fentanyl on the sympathomimetic response to laryngoscopy and intubation
in vascular surgeries. Karnataka Anaesth J 2015;1:64-8.
8. Woloszyn AV, McAllen KJ, Figueroa BE, DeShane RS, Barletta JF. Neurocrit Care. Retrospective evaluation of nicardipine versus labetalol for blood pressure control in aneurysmal subarachnoid hemorrhage. 2012 Jun;16(3):376-80.
9. Nooh N, Abdelhalim AA, Abdullah WA, Sheta SA. Effect of remifentanil on the hemodynamic responses and recovery profile of patients undergoing single jaw orthognathic surgery. Int J Oral Maxillofac Surg. 2013 Aug;42(8):988-93.
10. Wilson DJ,Wallin JD, Vlachakis ND, Freis ED, Vidt DG, Michelson EL, et al. Intravenous labetalol in the treatment of severe hypertension and hypertensive emergencies. Am J Med 1983;75:95-102.
11. Jivraj S, Mazer CD, Baker AJ, Choi M, Hare GM. Case report: profound hypotension associated with labetalol therapy in a patient with cerebral aneurysms and subarachnoid hemorrhage. Can J Anaesth 2006;53:678-83.
12. Fromme GA, MacKenzie RA, Gould AB, Lund BA, Offord KP. Controlled hypotension for orthognatic surgery. Anesth Analg 1986;65:683-6.
13. Das A, Mukherjee A, Chhaule S, Chattopadhyay S, Halder PS, Mitra T, et al. Induced hypotension in ambulatory functional endoscopic sinus surgery: a comparison between dexmedetomidine and clonidine as premedication. A prospective, doubleblind, and randomized study. Saudi J Anesth 2016;10:71-7.
14. Kate MP, Hansen MB, Mouridsen K, Østergaard L, Choi V, Gould BE, McCourt R, Hill MD, Demchuk AM, Coutts SB, Dowlatshahi D, Emery DJ, Buck BH, Butcher KS; ICHADAPT Investigators. Blood pressure reduction does not reduce perihematoma oxygenation: a CT perfusion study. J Cereb Blood Flow Metab. 2014 Jan;34(1):81-6.
15. Starr JB, Tirschwell DL, Becker KJ. Stroke. Labetalol Use Is Associated With Increased In-Hospital Infection Compared With Nicardipine Use in Intracerebral Hemorrhage. 2017 Oct;48(10):2693-2698.
16. Kamal HM, Ash AbdEl-Rahman. Clevidipne for deliberate hypotension in functional endoscopic sinus surgery (FESS). EJCTA 2008;2:158-64.
17. Wu T, Yang J, Luo K, Wang Y, You X. The clinical application of compound induced hypotension during functional endoscopic sinus surgery. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2006;20:1126-9.
18. Scott DB. The use of labetalol in anaesthesia. Br J Clin Pharmacol 1982;13:133-5.
19. Jacobi KE, Bohm BE, Richauar AJ, Jacobi C, Hemmerling TM. Moderate controlled hypotension with sodium nitroprusside does not improve surgical condition or decrease blood loss in endoscopic sinus surgery. J Clin
Anesth 2000;12:202-7.
20. Nooij LS, Visser S, Meuleman T, Vos P, Roelofs R, de Groot CJ. The optimal treatment of severe hypertension in pregnancy: update of the role of nicardipine. Curr Pharm Biotechnol. 2014;15(1):64-9.
21. El-Shmaa NS, Ezz HAA, Younes A. The efficacy of Labetalol versus Nitroglycerin for induction of controlled hypotension during sinus endoscopic surgery. A prospective, double-blind and randomized study. J Clin Anesth 2017;39:154-8.
22. Nagat S, EL-Shmaa NS, Alsaid AEH, Younes A. To assess the efficacy of labetalol versus nitroglycerin for induction of controlled hypotension. JCA 2017;39:154-8.
23. Ghodraty M, Khatibi A, Rokhtabnak F, Maleki M, Parsa F. Comparing Labetalol and Nitroglycerine on Inducing Controlled Hypotension and Intraoperative Blood Loss in Rhinoplasty: A Single-Blinded Clinical Trial. Anesth Pain Med 2017;7:e13677.
24. Eltringham RJ, Young PN, Littlejohns PA, Robinson JM. A comparison of glyceryl trinitrate and labetalol as
hypotensive agents in microsurgery of the middle ear. Eur Heart J 1988;9:201-3.
25. Quijada-Manuitt MA, Escamilla Y, Vallano A, Cardesín A, Bernal-Sprekelsen M, Pontes C. Use of α2-Adrenergic Agonists to Improve Surgical Field Visibility in Endoscopy Sinus Surgery: A Systematic Review of Randomised Controlled Trials. Clin Ther 2018;40:136-49.
26. Cantarella G, La Camera G, Di Marco P, Grasso DC, Lanzafame B. Controlled hypotension during middle ear surgery: hemodynamic effects of remifentanil vs nitroglycerin. Ann Ital Chir 2018;89:283-6.
27. Hadavi MR, Zarei Y, Tarogh S. Comparison of effects of labetalol and nitroglycerine on intraoperative blood loss and surgical field quality in rhinoplasty surgery.World J Plast Surg 2015;4:60-5.
28. Schlunk F, Böhm M, Boulouis G, Qin T, Arbel M, Tamim I, Fischer P, Bacskai BJ, Frosch MP, Endres M, Greenberg SM, Ayata C. Secondary Bleeding During Acute Experimental Intracerebral Hemorrhage. Stroke 2019;50:1210-5.
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Dacryocystorhinostomy Labetalol Nitroglycerine Blood loss

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Sanatkar M, Ebrahim Soltani A, Takzare A. Comparison of Labetalol and Nitroglycerine on Intraoperative Bleeding in Patients Who Underwent Dacryocystorhinostomy. Acta Med Iran. 2020;57(9):531-536.