Comparison of Oral Preoperative Clonidine with Infusion of Intraoperative Labetalol on Bleeding during Tympanoplasty Surgery

Document Type : Original

Authors

1 Sinus and Surgical Endoscopic Research Center, Department of Otorhinolaryngology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Anesthesiology and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

4 Clinical Research Development Unit, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:
Surgical bleeding is one of the most critical complications in various surgical procedures. In middle ear surgery, managing bleeding is a significant challenge for anesthesiologists because even minor bleeding can obstruct the surgeon's vision and prolong the surgery. Our objective is to compare the impact of preoperative oral clonidine versus labetalol infusion on bleeding volume during tympanoplasty surgery.
Materials and Methods:
In this double-blind randomized controlled trial, tympanoplasty candidates were randomly assigned to three groups: the clonidine group (received 300 micrograms of clonidine tablets one hour before surgery with normal saline infusion during the operation), the control group (given a placebo tablet one hour before surgery with normal saline infusion during surgery), and the labetalol group (administered a placebo tablet one hour before surgery with labetalol infusion at a rate of 0.2 mg/kg of body weight per hour during surgery). We then evaluated the extent of intraoperative bleeding, systolic and diastolic blood pressure, mean arterial pressure, and heart rate at various time points until the end of the surgery.
Results:
Clonidine and labetalol were effective in reducing intraoperative bleeding compared to the control group. Grade 2 bleeding (minimal bleeding requiring intermittent suction) was the highest grade observed across all three groups and was consistently noted in all patients. Clonidine demonstrated greater efficiency in reducing systolic and diastolic blood pressure, mean arterial pressure, and heart rate compared to both labetalol and the control group.
Conclusion:
Premedication with clonidine or labetalol is associated with reduced intraoperative bleeding, improved surgical field visibility, and shorter duration of tympanoplasty procedures. This may potentially lead to increased satisfaction and success rates of the operation.

Keywords

Main Subjects

References

  1. Indorewala S, Adedeji TO, Indorewala A, Nemade G. Tympanoplasty outcomes: a review of 789 cases. Iranian journal of otorhinolaryngology. 2015;27(79):101-8.
  2. Ghadimi K, Levy JH, Welsby IJ. Perioperative management of the bleeding patient. British journal of anaesthesia. 2016;117(suppl 3):iii18-iii30.
  3. Cinčikas D, Ivaškevičius J, Martinkėnas JL, Balseris S. A role of anesthesiologist in reducing surgical bleeding in endoscopic sinus surgery. Medicina (Kaunas, Lithuania). 2010;46(11):730-4.
  4. Ranjan AK, Gulati A. Controls of Central and Peripheral Blood Pressure and Hemorrhagic/ Hypovolemic Shock. 2023; 12(3): 1108.
  5. Kelly EA, Gollapudy S, Riess ML, Woehlck HJ, Loehrl TA, Poetker DM. Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia. International forum of allergy & rhinology. 2013;3(6):474-81.
  6. Chowdhury T, Wilkinson M, Cappellani RB. Hemodynamic Perturbations in Deep Brain Stimulation Surgery: First Detailed Description. Frontiers in neuroscience. 2017;11:477.
  7. Gupta K, Bansal M, Gupta PK, Pandey M, Agarwal S. Dexmedetomidine infusion during middle ear surgery under general anaesthesia to provide oligaemic surgical field: A prospective study. Indian journal of anaesthesia. 2015;59(1):26.
  8. Gupta N, Talwar V, Prakash S, Deuri A, Gogia AR. Evaluation of the efficacy of desflurane with or without labetalol for hypotensive anesthesia in middle ear microsurgery. J Anaesthesiol Clin Pharmacol. 2017;33(3):375-80.
  9. Giovannitti JA, Jr., Thoms SM, Crawford JJ. Alpha-2 adrenergic receptor agonists: a review of current clinical applications. Anesthesia progress. 2015; 62(1):31-9.
  10. Raghuwanshi SK, Chakravarty N, Asati DP, Bankwar V. Use of clonidine as an adjuvant to infiltration anaesthesia in tympanoplasty: a randomized double blind study. Indian J Otolaryngol Head Neck Surg. 2014;66(1):57-62.
  11. MacCarthy EP, Bloomfield SS. Labetalol: a review of its pharmacology, pharmacokinetics, clinical uses and adverse effects. Pharmacotherapy. 1983;3(4):193-219.
  12. Nadri s, Kazami s, Moradi m, Mahmoudvand h, Ahmadi Rokn abadi r, Papi oa. The effect of oral clonidine pre-medication prior to anesthesia on bleeding during tympanoplasty. Yafteh. 2014;16(1):43-51.
  13. Szpalski M, Gunzburg R, Sztern BJEsj. An overview of blood-sparing techniques used in spine surgery during the perioperative period. 2004; 13(Suppl 1):S18-S27.
  14. Toivonen J, Kaukinen S. Clonidine premedication: a useful adjunct in producing deliberate hypotension. Acta anaesthesiologica scandinavica. 1990;34(8):653-7.
  15. Marchal JM, Gómez-Luque A, Martos-Crespo F, Sánchez De La Cuesta F, Martínez-López MC, Delgado-Martinez AD. Clonidine decreases intraoperative bleeding in middle ear microsurgery. Acta Anaesthesiol Scand. 2001;45(5):627-33.
  16. Welfringer P, Manel J, Garric J, editors. Clonidine en premedication et anesthesie a l'isoflurane pour la reduction du saignement en chirurgie otologique. Annales françaises d'anesthésie et de réanimation; 1992: Elsevier.
  17. Ramchandani S, Lakra AM, Shah PJ, Lalwani J, Sahare KK. Effect of intravenous clonidine premedication for the bloodless surgical field in patients undergoing middle ear or nasal surgery: A comparison of three different doses. Anesth Essays Res. 2015;9(3):397-400.
  18. Ebneshahidi A, Mohseni M. Premedication with oral clonidine decreases intraoperative bleeding and provides hemodynamic stability in cesarean section. Anesth Pain Med. 2011;1(1):30-3.
  19. Jab AM, Hashemi J, Hashemi M, Soltani H. Oral clonidine premedication decreases intraoperative bleeding in patients undergoing endoscopic sinus surgery. 2005.
  20. Hajymohammadi F, Farad F, Taheri A, Hoozan B. Clonidine decreases intra operative bleeding in endoscopic surgery. Tehran Univ Med J. 2002; 60(5): 378-82.
  21. Welfringer P, Manel J, Garric J, editors. Clonidine premedication and isoflurane anesthesia to reduce bleeding in otologic surgery. Annales Francaises D'anesthesie et de Reanimation; 1992.
  22. Taghipour Anvari Z, Afshar-Fereydouniyan N, Imani F, Sakhaei M, Alijani B, Mohseni M. Effect of clonidine premedication on blood loss in spine surgery. Anesth Pain Med. 2012;1(4):252-6.
  23. Hackmann T, Friesen M, Allen S, Precious DS. Clonidine facilitates controlled hypotension in adolescent children. Anesth Analg. 2003;96(4):976-81.
  24. Ommi D, Teymourian H, Zali A, Ashrafi F, Moghaddam MJ, Mirkheshti A. Effects of clonidine premedication on intraoperative blood loss in patients with and without opium addiction during elective femoral fracture surgeries. Anesthesiology and Pain Medicine. 2015;5(4).
  25. 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 journal of plastic surgery. 2015;4(1):60-5.
  26. Okuyama K, Inomata S, Toyooka H. The effects of prostaglandin E1 or oral clonidine premedication on blood loss during paranasal sinus surgery. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 2005;52(5):546-7.
  27. Velasquez MT, Rho J, Maronde RF, Barr J. Plasma clonidine levels in hypertension. Clin Pharmacol Ther. 1983;34(3):341-6.
  28. Lavere PF, Rana NA, Kinsky MP, Funston JS, Mohamed SS, Chaaban MR. Blood Loss and Visibility with Esmolol vs Labetalol in Endoscopic Sinus Surgery: A Randomized Clinical Trial. Clinical medicine insights Ear, nose and throat. 2019;12:1179550619847992.
  29. Stuhmeier K-D, Mainzer B, Cierpka J, Sandmann W, Tarnow J. Small, oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. The Journal of the American Society of Anesthesiologists. 1996;85(4):706-12.
  30. Matot I, Sichel JY, Yofe V, Gozal Y. The Effect of Clonidine Premedication on Hemodynamic Responses to Microlaryngoscopy and Rigid Bronchoscopy. Anesthesia & Analgesia. 2000; 91(4).

 

 

 

Iranian Journal of Otorhinolaryngology
Volume 37, Issue 3
May and June 2025
Pages 105-113

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