Effect of preoperative oral bisoprolol on intraoperative outcomes in endoscopic sinus surgery

Background: Endoscopic sinus surgery (ESS) presents challenges in managing intraoperative bleeding and hemodynamic stability. This study evaluates the efficacy of pre-operative oral bisoprolol in improving surgical conditions and outcomes in ESS. Methods: This study was conducted between March 2021 and June 2022 at the department of anaesthesia, Bangabandhu Sheikh Mujib medical University, Dhaka, Bangladesh. This randomized controlled trial was conducted with 50 participants undergoing elective ESS, divided into bisoprolol and placebo groups. Result: The study involved 50 participants undergoing elective ESS, with 25 in the bisoprolol group and 25 in the placebo group. While demographic characteristics, such as age, weight, height, and gender distribution, showed no statistically significant differences between the groups. The placebo group experienced significantly higher estimated blood loss (421.72 ml vs. 156.24 ml, p<0.001) and postoperative hemoglobin levels (12.88 g/dl vs. 11.07 g/dl, p<0.001) compared to the bisoprolol group. Hemodynamic parameters, particularly heart rate, exhibited significant differences at various time points, with the bisoprolol group maintaining a higher heart rate post-premedication, intra-operatively, and post-operatively (p<0.05 for all). In the assessment of intraoperative bleeding using the Fromme-Boezaart scale, the placebo group demonstrated higher incidences of severe bleeding grades (3 and 4) compared to the bisoprolol group, with these differences being statistically significant (p<0.001). Conclusions: Pre-operative oral bisoprolol in ESS patients significantly reduces intraoperative bleeding and anesthetic requirements while maintaining hemodynamic stability. These findings suggest bisoprolol as a beneficial pre-operative medication in ESS, warranting further research to optimize surgical outcomes