A comparison between nitroprusside and nitroglycerine for hypotensive anesthesia in ear, nose, and throat surgeries: A double-blind randomized study

Abstract

Context: Blood obscures the operative field and makes precise technique difficult, and to the anesthetist, when the volume of blood lost is large. Practice of induced hypotension in the otolaryngology is a common practice owing to its benefits in providing a better visibility and preventing blood loss. Aims: The aim was to compare controlled induced hypotension for facilitating surgical exposure, and reducing intraoperative blood loss using sodium nitroprusside and nitroglycerin in ear, nose, and throat surgeries under general anesthesia. Settings and Design: A prospective, randomized, double-blind study. Materials and Methods: The study was carried out in 60 adults, American Society of Anesthesiologists grade I and II patients, allocated randomly in to three groups: group A was control group, group B patients received nitroprusside (0.5-10 μg/kg/min) and group C patients received nitroglycerine (1-10 μg/kg/min). Mean arterial pressure was maintained in the range of 50-60 mmHg. Statistical Analysis Used: Statistical Package for Social Sciences version 17.0 (ANOVA) followed by independent samples t-test and Chi-square test. Results: The results of the present study indicate that the use of controlled hypotension provides a better surgical field and reduces the blood loss. Of the two modalities under question, use of sodium nitroprusside gives the desired results in a significantly, shorter time as compared to nitroglycerin; however, the use of sodium nitroprusside must be carried out with caution as it has toxic effects. Conclusions: (1) The achievement of target level was quicker in sodium nitroprusside group as compared to nitroglycerin group. (2) Reflex tachycardia was the main side effect of the nitroglycerin group. (3) Rebound hypertension was the associated side effect of the sodium nitroprusside group.