Effects of Smoking on Controlled Hypotension with Nitroglycerin during Ear‑Nose‑Throat Surgery

Abstract

Background and Aim: In this study, the aim was to research the effects of smoking habits on controlled hypotension administered with  nitroglycerin during ear-nose-throat surgery.

Materials and Methods: This study administered controlled hypotension with nitroglycerin  and total intravenous anesthesia to a total of 80 patients undergoing septoplasty operations. The patients were divided into  two groups of 40 non-smokers (Group 1) and 40 smokers (Group 2). Intravenous propofol infusion was used for anesthesia  maintenance. Nitroglycerin with 0.25–1 μg/kg/min dose was titrated to provide controlled hypotension. During this process, the  hemodynamic parameters of patients, total propofol and nitroglycerin amounts used, operation duration, and duration of controlled hypotension were recorded at the end of the operation. At the end of the operation, the surgeon assessed the lack of blood in the  surgical field with Fromme Scale.

Results: Fromme scale values were significantly higher in Group 2 compared to Group 1. The MAP  values at 10, 20, 30 min, and end of operation were lower, while 10- and 20-min heart rate values were higher in Group 2 compared to Group 1.

Conclusion: Nitroglycerin, chosen for controlled hypotension to reduce hemorrhage in the surgical field during nasal surgery,  was shown to cause more pronounced hypotension and reflex tachycardia due to endothelial dysfunction linked to nicotine in patients  who smoke. Despite lower pressure values in the smoking group, the negative effects of nicotine on platelet functions combined with  similar effects of nitroglycerin to increase bleeding amounts.