Allergy/Rhinology

Preoperative β-blockade and hypertension in the first hour of functional endoscopic sinus surgery

Corresponding Author

Samuel A. Schechtman MD

[email protected]

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

Send correspondence to Samuel A. Schechtman, MD, Department of Anesthesiology, University of Michigan Health System, 1H247 UH, SPC 5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048. E-mail: [email protected]Search for more papers by this author

Aileen P. Wertz MD,

Aileen P. Wertz MD

Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

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Amy Shanks PhD,

Amy Shanks PhD

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

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Aleda Thompson MS,

Aleda Thompson MS

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

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Kevin Tremper PhD, MD,

Kevin Tremper PhD, MD

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

Dr. Kevin Tremper has an equity position with AlertWatch. Dr. David Healy is a paid advisor for Brio Device LLC.

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Melissa A. Pynnonen MD, MSc,

Melissa A. Pynnonen MD, MSc

Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

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David W. Healy MD, MRCP, FRCA,

David W. Healy MD, MRCP, FRCA

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

Dr. Kevin Tremper has an equity position with AlertWatch. Dr. David Healy is a paid advisor for Brio Device LLC.

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Samuel A. Schechtman MD,

Corresponding Author

Samuel A. Schechtman MD

[email protected]

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

Aileen P. Wertz MD,

Aileen P. Wertz MD

Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

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Amy Shanks PhD,

Amy Shanks PhD

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

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Aleda Thompson MS,

Aleda Thompson MS

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

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Kevin Tremper PhD, MD,

Kevin Tremper PhD, MD

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

Dr. Kevin Tremper has an equity position with AlertWatch. Dr. David Healy is a paid advisor for Brio Device LLC.

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Melissa A. Pynnonen MD, MSc,

Melissa A. Pynnonen MD, MSc

Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

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David W. Healy MD, MRCP, FRCA,

David W. Healy MD, MRCP, FRCA

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, U.S.A

Dr. Kevin Tremper has an equity position with AlertWatch. Dr. David Healy is a paid advisor for Brio Device LLC.

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First published: 03 February 2017

https://doi.org/10.1002/lary.26492

Citations: 6

The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objectives/Hypothesis

Local anesthetic with epinephrine is commonly injected into the nasal mucosa during functional endoscopic sinus surgery (FESS). Systemic absorption of epinephrine following local injection may occur, resulting in a mild sympathetic response. This study seeks to determine whether an exaggerated sympathetic response to epinephrine is demonstrated in patients undergoing FESS treated preoperatively with established pharmacologic beta (β) adrenoceptor blockade.

Study Design

A retrospective analysis of adult patients undergoing FESS at a tertiary care university hospital.

Methods

The primary outcome was the occurrence of an exaggerated hypertensive response within the first hour of surgical time defined by a relative increase (>20%) in the first measured intraoperative systolic blood pressure (SBP) prior to induction of anesthesia, or a single SBP value above 200 mm Hg. A mixed effects logistic regression model was developed to identify independent predictors of an exaggerated hypertensive response and describe the variance in the outcome attributable to the surgeon and anesthesiologist.

Results

There were 2,051 patients identified. Independent predictors of an exaggerated intraoperative hypertensive event included: preoperative β-blocker use (adjusted odds ratio [AOR]: 3.33), female gender (AOR: 1.92), body mass index (AOR: 1.03), lower baseline SBP (AOR: 0.93), and advanced age (AOR: 1.03). The C statistic for the model was 0.8881.

Conclusions

Preoperative β-blocker use is an independent predictor of an exaggerated hypertensive response within the first hour of operative time. An exaggerated hypertensive effect should be anticipated in patients presenting for FESS with established pharmacologic β-blockade, and caution should be applied to use of epinephrine-containing solutions.

Level of Evidence

4. Laryngoscope, 127:1496–1505, 2017

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Citing Literature

Volume127, Issue7

July 2017

Pages 1496-1505

Preoperative β-blockade and hypertension in the first hour of functional endoscopic sinus surgery

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Preoperative β-blockade and hypertension in the first hour of functional endoscopic sinus surgery

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

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