Berzan Haznedar1, *, Görkem Tutal Gürsoy2


1Diyarbakır Gaziyaşargil Training and Research Hospital, Department of Otolaryngology-Head and Neck Surgery, Diyarbakır, Turkey - 2Ankara City Hospital Neurology Clinic, Ankara, Turkey


Background: Considering the concept of controlled hypotension, it is known that it creates a bloodless surgical field by keeping the mean arterial pressure (MAP) between 50-70 mmHg in patients without hypertension or by reducing the basal MAP by 30% in patients with hypertension. Thus, it will be demonstrated that it is necessary for anesthetic blood transfusion, which increases the success of the operation and reduces the need. This method is frequently used in otorhinolaryngology and all other surgical procedures with a high bleeding potential. Objective: To investigate whether smoking has an effect on controlled hypotension administered with nitroglycerin in otolaryngological surgical procedures.

Methods: In our prospective and observational study, septoplasty was performed in 50 (Group 1) and 50 non-smoker patients by applying total intravenous anesthesia (TIVA) and controlled hypotension with nitroglycerin. Ethics committee approval was obtained for the study. The study was conducted with a total of 100 patients, 1 of whom was also a smoker (Group 2). Intravenous propofol infusion was also used as part of the maintenance of anesthesia, and nitroglycerin was titrated at a dose range of 0.25-1 µg/kg/min to provide controlled hypotension.

Results: There was no significant difference between the groups in demographic data, BMI (Body Mass Index) values, ASA (American Society of Anesthesiologists) classifications, operation times, controlled hypotension times, total propofol and nitroglycerin amounts used. However, Fromme scale values were found to be statistically significantly higher in smokers (Group 2) than in non-smoker patients (Group 1) (P<0.05).

Conclusion: It has been observed that nitroglycerin, which is preferred for controlled hypotension applied to reduce bleeding in the surgical field in nasal surgery, causes more pronounced hypotension and reflex tachycardia in smokers due to nicotine-induced endothelial dysfunction.


Controlled hypotension status, smoking, septoplasty, TIVA, nitroglycerin, nicotine.