Beta-blockers to reduce bleeding in functional endoscopic rhinosinus surgery

Objective: to compare the effectiveness of intravenous β-blockers (BAB) metoprolol and esmolol during general combined anesthesia to reduce intraoperative bleeding in functional endoscopic sinus surgery. Material and methods. A total of 112 patients were included in a single-center prospective cohort study. Functional endoscopic sinus surgical (FESS) interventions were performed under general anesthesia in the Otorhinolaryngological Clinic of the Institute of Surgery and Emergency Medicine of the Pavlov First Saint Petersburg State Medical University. Patients were randomized into 3 groups using simple random number generation: the control group (GC) without intraoperative administration of BAB (n=39); the group with intraoperative intravenous (IV) administration of metoprolol (GM) (n=36), the group with intraoperative IV administration of esmolol (GE) (n=37). General combined inhalation anesthesia with the addition of short-acting opioids and muscle relaxants was performed in all groups. All operations were performed by one surgeon who assessed the intraoperative intensity of bleeding (IB) of the surgical field using a 6-point Fromme-Boezaart scale at 10, 30, and 60 minutes of surgery (study points). Heart rate (HR), noninvasive mean blood pressure (MBP), perfusion index (PI) were also recorded at the same timepoints. Results. The values of the awakening time and the consumption of narcotic analgesic – fentanyl in GC were significantly higher than in GM and GE. The IB values in GM and GE were significantly lower at all points of the study. The HR in the GC at the 10th and 30th minutes of the procedure was higher compared to GM and GE. At the 60th minute of the procedure, HR in the GM and GE groups was significantly lower compared with the control group, and HR in GE was lower compared with GM similarly to that at the 30th minute of surgery. To assess the impact of intraoperative hemodynamic parameters (HR, MBP, PI) and the use of BAB on the intraoperative bleeding intensity, a multifactorial analysis was performed. At the 10th minute, the chances of significant bleeding (SB), which corresponds to IB≥2, increased by 1.1 with an increase in HR by 1 bpm. The chances of developing SB decreased by 11.4 times in GM (metoprolol) and by 9.6 times in GE (esmolol). At the 30th minute, an increase in HR by 1 bpm increased the chances of developing SB 1.1 times. At the 60th minute, an increase in HR by 1 bpm raised the chances of developing of SB by 1.2 times. Conclusions. Metoprolol and esmolol given at recommended doses as a component of general anesthesia are equally effective for reducing intraoperative intensity of bleeding during functional FESS procedures. Esmolol in comparison with metoprolol in the recommended doses causes more significant decrease in heart rate and MBP. Key words: beta-blockers, metoprolol, esmolol, intensity of bleeding, bleeding control, functional endoscopic sinus surgery, FESS Conflicts of interest. The authors have no conflicts of interest to declare. Funding. There was no funding for this study