Study Hypothesis: Hypotensive protocol consisted of oral labetalol pre-medication and low-dose intraoperative (I0) labetalol infusion can improve surgical outcome of open abdominal myomectomy (OAM) than JO tourniquet compression.
Study Design: Eighty-six women were randomly allocated into two equal groups: control group received normotensive anesthesia with application of uterine tourniquet for JO hemostasis and study group included patients followed the hypotensive protocol till completion of myomectomy. Surgical and anesthetic outcomes and surgeons' satisfaction were determined.
Results: Three study patients required tourniquet application for control of bleeding. In study patients, mean field visibility score was non-significantly higher, but operative time, JO blood loss and need for transfusion were significantly lower and JO urine output was significantly higher. PO hemoglobin deficit was significantly lower. Hypotensive protocol allowed significant blunting of pressor reflexes to tracheal intubation and extubation and maintained non-singificant variations of heart rate (HR) and mean arterial pressure (MAP) measures during myomectomy. Postoperative HR and MAP measures were significantly lower in study patients compared to their baseline and to PO measures in patients of control group till 6-hr PO. Frequency of patients developed PO bleeding and hospital stay was significantly lower in study group. Surgeons' satisfaction by hypotensive anesthesia for OAM was non-significantly higher than by tourniquet hemostasis.
Conclusion: Hypotensive anesthesia using oral labetalol pre-medication and low-dose JO labetalol infusion significantly reduced HR and MAP till immediate PO period versus classic JO tourniquet compression. Proper hemodynamic control significantly reduced open myomectomy associated bleeding complications, improved field visibility and so allowed perfect hemostasis within significantly shorter operative time than with tourniquet control of hemostasis.