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  • Title: [Controlled hypotension for tympanoplasty: comparison between remifentanil and combination of alfentanil and sodium nitroprusside].
    Author: Hanci A, Karahan T, Sivrikaya GU, Başgül A, Coşkun BU.
    Journal: Kulak Burun Bogaz Ihtis Derg; 2007; 17(6):311-7. PubMed ID: 18187995.
    Abstract:
    OBJECTIVES: We compared the efficacy of remifentanil and the combination of alfentanil and sodium nitroprusside on controlled hypotension and bleeding at surgical site. PATIENTS AND METHODS: Thirty ASA I-II patients undergoing tympanoplasty were randomly assigned to remifentanil and alfentanil-sodium nitroprusside groups, equal in number. Anesthesia was induced with remifentanil or alfentanil combined with propofol and rocuronium, and maintained with remifentanil or alfentanil-sodium nitroprusside infusions combined with propofol. All patients were ventilated with a mixture of 33% O2 and 66% N2O. Invasive mean arterial blood pressure, heart rate, peripheral oxygen saturation, the amount of bleeding at surgical site, and blood gas values were recorded. RESULTS: Controlled hypotension was achieved at a target mean arterial pressure of 60+/-5 mmHg in both groups. Compared to the baseline levels, heart rate values were lower in the remifentanil group (p<0.05), and similar in the sodium nitroprusside group (p>0.05). The amount of bleeding and the dryness of the surgical site were similar in two groups. PaCO2 and pH values differed significantly between the two groups at perioperative 1 and 2 hours and in the postoperative 30th minute (p<0.05), but the difference was not clinically significant. CONCLUSION: Our results suggest that remifentanil is effective in obtaining controlled hypotension without an additional potent hypotensive agent and provides appropriate surgical conditions by reducing the amount of bleeding.
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