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Hypotensive anaesthesia with remifentanil combined with desflurane or isoflurane in tympanoplasty or endoscopic sinus surgery: a randomised, controlled trial

Published online by Cambridge University Press:  21 February 2008

K Kaygusuz ,
A Yildirim ,
I Ozdemir Kol ,
S Gursoy  and
C Mimaroglu
K Kaygusuz*
Affiliation:
Department of Anaesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey
A Yildirim
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Cumhuriyet University School of Medicine, Sivas, Turkey
I Ozdemir Kol
Affiliation:
Department of Anaesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey
S Gursoy
Affiliation:
Department of Anaesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey
C Mimaroglu
Affiliation:
Department of Anaesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey
*
Address for correspondence: Dr Kenan Kaygusuz, Department of Anaesthesiology, Cumhuriyet University School of Medicine, 58140 Sivas, Turkey. Fax: +346 2581304 E-mail: kaygusuzkenan@gmail.com
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Abstract

Objective:

To compare the effect of remifentanil combined with desflurane or isoflurane on the quality of the operative field and surgical conditions, blood loss, and recovery during tympanoplasty or endoscopic sinus surgery.

Design:

Randomised, double-blinded clinical study.

Subjects:

Sixty-four patients were scheduled for elective tympanoplasty or endoscopic sinus surgery. The patients were randomly divided into two groups: desflurane or isoflurane. After anaesthesia induction, all patients received a continuous remifentanil infusion of 0.2–0.5 µg/kg/min until a mean arterial pressure of 65–75 mmHg was achieved. Heart rate and mean arterial pressure were recorded throughout anaesthesia. Blood loss was measured at the end of surgery. Achievement of a bloodless operative field was rated on a 100 mm visual analogue scale. Following completion of surgery, the time to extubation and to achievement of an Aldrete score of nine or more was recorded.

Results:

Sixty-three patients were evaluated. The total dose of remifentanil and the total blood loss were similar in both groups (p > 0.05). Time to extubation and to an Aldrete score of nine or more for the desflurane group was significantly less than for the isoflurane group (p < 0.05). No differences were found in the extent of achievement of a bloodless operative field, as assessed via visual analogue scale, comparing the study groups (p > 0.05).

Conclusion:

Although desflurane and isoflurane both enabled good surgical conditions (in terms of quality of operative field) and convenient induction of hypotension for tympanoplasty and endoscopic sinus surgery, the recovery characteristics of desflurane were better than those of isoflurane. Therefore, desflurane may be preferable to isoflurane in such circumstances.

Keywords

DesfluraneIsofluraneTympanoplastyOtorhinolaryngologic Surgical ProceduresHypotension
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 7 , July 2008 , pp. 691 - 695
Copyright
Copyright © JLO (1984) Limited 2008

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References

1 Degoute, CS, Ray, MJ, Manchon, M, Dubreuil, C, Banssillon, V. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth 2001;48:20–7CrossRefGoogle ScholarPubMed
2 Eberhart, LH, Folz, BJ, Wulf, H, Geldner, G. Intravenous anaesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope 2003;113:1369–73CrossRefGoogle ScholarPubMed
3 Elsharnouby, NM, Elsharnouby, MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth 2006;96:727–31Google Scholar
4 Degoute, CS, Dubreuil, C, Ray, MJ, Guitton, J, Manchon, M, Banssillon, V et al. Effects of posture, hypotension and locally applied vasoconstriction on the middle ear microcirculation in anaesthetized humans. Eur J Appl Physiol 1994;69:414–20CrossRefGoogle ScholarPubMed
5 Saarnivaara, L, Klemola, UM, Lindgren, L. Labetolol as a hypotensive agent for middle ear microsurgery. Acta Anaesthesiol Scand 1987;31:196–201CrossRefGoogle ScholarPubMed
6 Pavlin, JD, Colley, PS, Weymuller, EA Jr, Van Norman, G, Gunn, HC, Koerschgen, ME. Propofol versus isoflurane for endoscopic sinus surgery. Am J Otolaryngol 1999;20:96–101CrossRefGoogle ScholarPubMed
7 Dal, D, Celiker, V, Ozer, E, Başgül, E, Salman, MA, Aypar, U. Induced hypotension for tympanoplasty: a comparison of desflurane, isoflurane and sevoflurane. Eur J Anaesthesiol 2004;21:902–6CrossRefGoogle ScholarPubMed
8 Fromme, GA, MacKenzie, RA, Gould, AB Jr, Lund, BA, Offord, KP. Controlled hypotension for orthognathic surgery. Anesth Analg 1986;65:683–6CrossRefGoogle ScholarPubMed
9 Sivaci, R, Yilmaz, MD, Balci, C, Erincler, T, Unlu, H. Comparison of propofol and sevoflurane anesthesia by means of blood loss during endoscopic sinus surgery. Saudi Med J 2004;25:1995–8Google ScholarPubMed
10 Cincikas, D, Ivaskevicius, J. Application of controlled arterial hypotension in endoscopic rhinosurgery. Medicina 2003;39:852–9Google ScholarPubMed
11 Jacobi, KE, Bohm, BE, Rickauer, AJ, Jacobi, C, Hemmerling, TM. Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery. J Clin Anesth 2000;12:202–7CrossRefGoogle ScholarPubMed
12 Leigh, JM. The history of controlled hypotension. Br J Anaesth 1975;47:745–9Google Scholar
13 Lim, YJ, Kim, CS, Bahk, JH, Ham, BM, Do, SH. Clinical trial of esmolol-induced controlled hypotension with or without acute normovolemic hemodilution in spinal surgery. Acta Anaesthesiol Scand 2003;47:74–8CrossRefGoogle ScholarPubMed
14 Boezaart, AP, Van der Merwe, J, Coetzee, A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic surgery. Can J Anaesth 1995;42:373–6CrossRefGoogle Scholar
15 Lessard, MR, Trepanier, CA, Baribault, JP, Brochu, JG, Brousseau, CA, Cote, JJ et al. Isoflurane-induced hypotension in orthognathic surgery. Anesth Analg 1989;69:379–83CrossRefGoogle ScholarPubMed
16 Bertrand, D, Boivin, G, Manel, J, Laxenaire, MC. Effects of isoflurane on bleeding in microsurgery of the middle ear [in French]. Ann Fr Anesth Reanim 1987;6:416–18Google Scholar
17 Preckel, MP, Ferber-Viart, C, Leftheriotis, G, Dubreuil, C, Duclaux, R, Saumet, JL et al. Autoregulation of human inner ear blood flow during middle ear surgery with propofol or isoflurane anesthesia during controlled hypotension. Anesth Analg 1998;87:1002–8CrossRefGoogle ScholarPubMed
18 Beaussier, M, Paugam, C, Deriaz, H, Mestari, M, Chandon, M, Sautet, A et al. Haemodynamic stability during moderate hypotensive anaesthesia for spinal surgery. A comparison between desflurane and isoflurane. Acta Anaesthesiol Scand 2000;44:1154–9Google Scholar
19 Loop, T, Priebe, HJ. Recovery after anesthesia with remifentanil combined with propofol, desflurane, or sevoflurane for otorhinolaryngeal surgery. Anesth Analg 2000;91:123–9Google Scholar