Effect of preoperative oral bisoprolol on intraoperative outcomes in endoscopic sinus surgery

M. Abdul Alim; Mohammad Shafiqul Islam; Dilip Kumar Bhoumik; Sheikh Hasanur Rahman; Mohammad Wahiduzzaman; Ranjit Kumar Ghosh; Roksana Akter

doi:10.18203/2320-6012.ijrms20240198

Authors

M. Abdul Alim Department of Anaesthesia, Analgesia and Intensive Care Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Mohammad Shafiqul Islam Department of Anaesthesia, Analgesia and Intensive Care Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Dilip Kumar Bhoumik Department of Anaesthesia, Analgesia and Intensive Care Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Sheikh Hasanur Rahman Department of Otolaryngology and Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Mohammad Wahiduzzaman Department of Otolaryngology and Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Ranjit Kumar Ghosh Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Roksana Akter Department of Obstetrics and Gynaecology, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20240198

Keywords:

Bisoprolol, Sinus surgery, Beta blocker, Surgical field visibility

Abstract

Background: Endoscopic sinus surgery (ESS) presents challenges in managing intraoperative bleeding and hemodynamic stability. This study evaluates the efficacy of pre-operative oral bisoprolol in improving surgical conditions and outcomes in ESS.

Methods: This study was conducted between March 2021 and June 2022 at the department of anaesthesia, Bangabandhu Sheikh Mujib medical University, Dhaka, Bangladesh. This randomized controlled trial was conducted with 50 participants undergoing elective ESS, divided into bisoprolol and placebo groups.

Result: The study involved 50 participants undergoing elective ESS, with 25 in the bisoprolol group and 25 in the placebo group. While demographic characteristics, such as age, weight, height, and gender distribution, showed no statistically significant differences between the groups. The placebo group experienced significantly higher estimated blood loss (421.72 ml vs. 156.24 ml, p<0.001) and postoperative hemoglobin levels (12.88 g/dl vs. 11.07 g/dl, p<0.001) compared to the bisoprolol group. Hemodynamic parameters, particularly heart rate, exhibited significant differences at various time points, with the bisoprolol group maintaining a higher heart rate post-premedication, intra-operatively, and post-operatively (p<0.05 for all). In the assessment of intraoperative bleeding using the Fromme-Boezaart scale, the placebo group demonstrated higher incidences of severe bleeding grades (3 and 4) compared to the bisoprolol group, with these differences being statistically significant (p<0.001).

Conclusions: Pre-operative oral bisoprolol in ESS patients significantly reduces intraoperative bleeding and anesthetic requirements while maintaining hemodynamic stability. These findings suggest bisoprolol as a beneficial pre-operative medication in ESS, warranting further research to optimize surgical outcomes.

Metrics

Metrics Loading ...

References

Homsi MT, Gaffey MM. Sinus Endoscopic Surgery. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.

Kelly EA, Gollapudy S, Riess M, Woehlck HJ, Poetker DM. Quality of surgical field during endoscopic sinus surgery: A systematic literature review of the effect of total intravenous compared to inhalational anesthesia. Int Forum Allergy Rhinol. 2013;3(6):474-81.

Byun H, Chung JH, Lee SH, Ryu J, Kim C, Shin JH. Association of Hypertension with the Risk and Severity of Epistaxis. JAMA Otolaryngol Head Neck Surg. 2021;147(1):1-7.

Li H, Du Y, Yang W, Wang Y, Su S, Zhao X et al. Inhalational Anesthesia is Noninferior to Total Intravenous Anesthesia in Terms of Surgical Field Visibility in Endoscopic Sinus Surgery: A Randomized, Double-Blind Study. Drug Des Devel Ther. 2023;17:707-16.

Crowther M, van der Spuy K, Roodt F, Nejthardt MB, Davids JG, Roos J et al. The relationship between pre-operative hypertension and intra-operative haemodynamic changes known to be associated with postoperative morbidity. Anaesthesia. 2018;73(7):812-8.

Wesselink EM, Wagemakers SH, van Waes JAR, Wanderer JP, van Klei WA, Kappen TH. Associations between intraoperative hypotension, duration of surgery and postoperative myocardial injury after noncardiac surgery: a retrospective single-centre cohort study. Br J Anaesth. 2022;129(4):487-96.

Elnakera AM, Wagdy MH, Abd-Elgelyl AA, El-Anwar MW. Preoperative gabapentin versus bisoprolol for haemodynamic and surgical field optimisation during endoscopic sinus surgery: A randomised controlled trial. Indian J Anaesth. 2021;65(2):121-7.

Tegegne SS, Gebregzi AH, Arefayne NR. Deliberate hypotension as a mechanism to decrease intraoperative surgical site blood loss in resource limited setting: A systematic review and guideline. Int J Surg Open. 2021;29:55-65.

Bazroon AA, Alrashidi NF. Bisoprolol. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.

Jacob SM, Chandy TT, Cherian VT. Oral bisoprolol improves surgical field during functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol. 2014;30(1):59-64.

Wongcharoen W, Chotayaporn T, Chutikhongchalermroj K, Tantraworasin A, Saeteng S, Arworn S et al. Effects of short-term bisoprolol on perioperative myocardial injury in patients undergoing non-cardiac surgery: a randomized control study. Sci Rep. 2021;11(1):22006.

Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995;42(5):373-6.

Sanjiv N, Osathanugrah P, Harrell M, Siegel NH, Ness S, Chen X et al. Race and ethnic representation among clinical trials for diabetic retinopathy and diabetic macular edema within the United States: A review. J Natl Med Assoc. 2022;114(2):123-40.

Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.

Sophia P, Lakshmi BS, Prasad PK, Chandramouli K. Pre-operative oral bisoprolol improves the surgical field during functional endoscopic sinus surgery: A randomized, controlled, prospective and double-blinded study. Int J Scientific Study. 2015;2(10):47-51.

Guay J, Andrew Ochroch E. Beta-Blocking Agents for Surgery: Influence on Mortality and Major Outcomes. A Meta-Analysis. J Cardiothoracic Vascular Anesth. 2013;27(5):834-44.

AL-Quossi MAHR. Comparative Study Between the Efficacy of Verapamil and Bisoprolol on Reduction of Bleeding During Endoscopic Sinus Surgery Under General Anaesthesia. clinicaltrials.gov; 2021. Report No.: NCT04356196. Available at: https://clinicaltrials.gov/study/NCT04356196. Accessed on 1 January, 2023.

Zhang X, Qi S, Lin Z, Zhang Y, Dai W, Tian W et al. Pre-operative administration of butorphanol mitigates emergence agitation in patients undergoing functional endoscopic sinus surgery: A randomized controlled clinical trial. Front Psychiatr. 2022;13:1090149.

Bonelli J, Staribacher H. Haemodynamic effects of bisoprolol in patients with coronary heart disease: influence of various bisoprolol plasma concentrations. J Cardiovasc Pharmacol. 1986;8(11):S83-86.

Blessberger H, Lewis SR, Pritchard MW, Fawcett LJ, Domanovits H, Schlager O et al. Perioperative beta‐blockers for preventing surgery‐related mortality and morbidity in adults undergoing non‐cardiac surgery. Cochrane Database System Rev. 2019;(9).

Tang H, Chen K, Hou J, Huang X, Liu S, Hu S. Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric. BMC Cardiovascular Disord. 2021;21(1):552.

Shah A, Palmer AJR, Klein AA. Strategies to minimize intraoperative blood loss during major surgery. Bri J Surg. 2020;107(2):e26-38.