Pharmacologic management of bleeding during sinus surgery

Investigators may have identified safe and effective hypotensive agents in patients undergoing endoscopic sinus surgery.

In a systematic review and network meta-analysis published in JAMA Otolaryngology-Head & Neck Surgery, the investigators used the PubMed, Scopus, Web of Science and Cochrane databases to identify 52 randomized clinical trials involving more than 3,500 patients who received either hypotensive agents or placebo to manage intraoperative bleeding in endoscopic sinus surgery.

Compared with placebo, dexmedetomidine was the most effective in reducing mean arterial pressure; bisoprolol was the most effective in reducing the heart rate at 60 minutes; and both esmolol and labetalol supported quicker recovery. Alongside dexmedetomidine, esmolol and labetalol, the drugs diltiazem and clonidine were also found to be effective in decreasing intraoperative bleeding compared with placebo.

The investigators emphasized that use of the hypotensive agents helped improve the surgical field quality during endoscopic sinus surgery.

Read more: JAMA Otolaryngology-Head & Neck Surgery

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