Hypotensive anaesthesia with remifentanil combined with desflurane or isoflurane
in tympanoplasty or endoscopic sinus surgery: a randomised, controlled trial.
Author(s): Kaygusuz K, Yildirim A, Kol IO, Gursoy S, Mimaroglu C.
Affiliation(s): Department of Anaesthesiology, Cumhuriyet University School of Medicine, Sivas,
Turkey. kaygusuzkenan@gmail.com
Publication date & source: 2008, J Laryngol Otol. , 122(7):691-5
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 microg/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).
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.
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