Esmolol vs. Labetalol in Endoscopic Sinus Surgery

Blood Loss and Visibility With Esmolol vs. Labetalol in Endoscopic Sinus Surgery: A Randomized Trial

The purpose of this study is to compare esmolol and labetalol bleeding and intra-operative visibility scores in functional endoscopic sinus surgery.

BACKGROUND: Improved intraoperative visibility during functional endoscopic sinus surgery (FESS) decreases the risk of serious orbital or skull base injuries. Beta blockers are among several methods used to reduce mean arterial pressure (MAP), heart rate (HR) and mucosal bleeding. Labetalol (mixed alpha-1-beta blocker) reduces HR and MAP; however, its alpha-1 blockade may mitigate topical epinephrine decongestant effects. Esmolol (selective beta-1 blocker) does not have direct antagonistic effects on topical epinephrine. This study compares the hemodynamic parameters (rate of blood loss, MAP control, HR) and intraoperative visibility during FESS between esmolol and labetalol.

Inclusion Criteria:

• History of CRS with or without nasal polyps
• Undergoing FESS for CRS
• American Society of Anesthesiologists (ASA) physical status 1 (healthy) or 2 (patient with mild systemic disease).

Exclusion Criteria:

• Pregnancy
• Asthma
• COPD
• Bradycardia
• Heart failure
• End stage renal disease
• Cerebrovascular accident
• Diabetes mellitus
• Preoperative use of NSAIDs, aspirin, or beta-blockers
• Body mass index (BMI) greater than 40 kg/m2.