Controlled hypotension for tympanoplasty: comparison between remifentanil and combination of alfentanil and sodium nitroprusside

Year 2007, Volume: 17 Issue: 6, 311 - 317, 24.11.2007

G. Ulufer Sivrikaya Ayşe Hancı Tuncay Karahan Ayda Başgül Berna Uslu Coşkun

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 l-ll 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 remi­ fentanil or alfentanil-sodium nitroprusside infusions combined with propofol. AH 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 betvveen the two groups at perioperative 1 and 2 hours and in the postoperative 30th minute p<0.05 , but the dif- ference was not clinically significant.Conclusion: Our results suggest that remifentanil is effec-tive in obtaining controlled hypotension vvithout an additional potent hypotensive agent and provides appropriate surgical conditions by reducing the amount of bleeding.

Keywords

Anesthesia, general, blood pressure, hypoten­ sion, controlled, sodium nitroprusside, analgesics, opioid, tympanoplasty

Timpanoplasti olgularında kontrollü hipotansiyon: Remifentanil ve alfentanil-sodyum nitroprusid kombinasyonunun karşılaştırılması

Abstract

Amaç: Remifentanil ile alfentanil-sodyum nitroprusid kombinasyonunun kontrollü hipotansiyon ve cerrahi alanda kanama üzerindeki etkinlikleri karşılaştırıldı.Hastalar ve Yöntemler: Timpanoplasti uygulanacak, ASA I-II, 30 hasta rasgele iki gruba ayrıldı. Remifentanil grubuna n=15 indüksiyonda remifentanil, propofol, roküronyum ve idamede remifentanil ve propofol infüzyonları; sodyum nitroprusid grubuna n=15 indüksiyonda alfentanil, propofol, roküronyum ve idamede alfentanil, propofol ve sodyum nitroprusid infüzyonları uygulandı. Olgular %33 O2 ve %66 N2O karışımıyla havalandırıldı. İnvaziv ortalama arter kan basıncı, kalp hızı, periferik oksijen satürasyonu, cerrahi alandaki kanama miktarı, kan gazı değerleri kaydedildi.Bulgular: Ameliyat süresince her iki grupta ortalama arter basıncı değerleri yaklaşık 60±5 mmHgʼde stabildi. Kalp hızı remifentanil grubunda kontrol değerinden düşük p0.05 . Kan kaybı ve cerrahi alanın kuruluğu her iki grupta benzerdi. İki grup arasında, ameliyat sırasında birinci ve ikinci saatlerle, ameliyat sonrası 30. dk pH ve PaCO2 değerlerinde anlamlı fark bulundu p

Keywords

Anestezi, genel, kan basıncı, hipotansiyon, kontrollü, sodyum nitroprusid, opioid analjezik, timpanoplasti

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