Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 5 1 2018 12 29 15 17 Mehdi Sanatkar Department of Anesthesiology, Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. Hossein Sadrossadat Department of Anesthesiology, Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. Mehrdad Goudarzi Department of Anesthesiology, Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. Ebrahim Espahbodi Department of Anesthesiology, Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. Masoumeh Zangeneh Department of Anesthesiology, Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. 2018 12 29 Background: This is a prospective randomized blinded clinical trial comparing the efficacy and safety of labetalol and nitroglycerin for the management of intraoperative hypertension in ambulatory surgical patients who underwent cataract surgery. Methods: A total of 80 hypertensive patients (systolic blood pressure> 200 mmHg or diastolic blood pressure>100 mmHg) who had increased blood pressure during cataract surgery under topical anesthesia were reviewed. Patients were randomized to receive nitroglycerin (group N, n=40) or labetalol (group L, n=40). The initial dose of nitroglycerin was a bolus of 2 µg/kg and repeat dose of 1ug/kg intravenously every 5 minutes. Labetalol was administered as a bolus of 5 mg followed by 5 mg intravenously as needed every five minutes up to maximum dose of 1 mg/kg. Results: Systolic blood pressure decreased from 21.4±8.6 mm Hg (200 to 260 mm Hg) to 18.8±6.4 mm Hg with administration of nitroglycerin. Labetalol reduced systolic blood pressure from 21.4±6.7 mm Hg (201 to 258 mm Hg) to 17.6±11.6 (p=0.02). Nitroglycerin increased baseline heart rate from 68±8 beats/min to 82±6 beats/min (p=0.04), however, in the labetalol group heart rate reduced from control 72±6 to 64±9 beats/min (P<0.05). The hypotension episode was 18 (45%) cases in the nitroglycerin group and 2 (5%) cases in the labetalol group respectively (p<0.05). The mean of systolic blood pressure during their stay in the recovery room in nitroglycerin group was 20.7±9.6 mm Hg and in labetalol group was 18.5±10.2 mm Hg (p<0.05). Conclusion: Nitroglycerin may produce reflex tachycardia and episode of hypotension especially in elderly patients intraoperatively. Labetalol is a safe and effective antihypertensive agent for management of increased blood pressure during cataract surgery with topical anesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/220 https://aacc.tums.ac.ir/index.php/aacc/article/download/220/400