Mediterr. J. Otol 2008; 4:(2)

Controlled hypotension: remifentanil or esmolol during tympanoplasty

Gozde Bumin Aydin, Onur Ozlu, Hale Alacakir, Mustafa Aksoy

Ministry of Health Dıskapı Education and Research Hospital, II. Anesthesiology and Reanimation Clinic, Ankara, Turkey. drgozdeaydin@yahoo.com 

Introduction:  Controlled hypotension is used to improve surgical conditions during middle ear surgery. New short acting drugs allow control of intraoperative blood pressure and improve surgical field for the surgeon. Our purpose is to determine whether remifentanil or esmolol could induce controlled hypotension, provide a  dry operative field.

Material and Methods: Thirty six adult patients undergoing tympanoplasty had an induction with  propofol  2 mg/kg, fentanyl 1 mg/kg and vecuronium 0.1mg/kg were randomly assigned in two groups to receive either 1 mg/kg remifentanil iv in 30-60 seconds, followed by a continuous infusion of 0.25-0.50 mg/kg/min, or 500 mg/kg esmolol iv in 30 seconds, followed by a continuous infusion of 100-300 mg/kg/min.

Results: Controlled hypotension was achieved at the target systolic arterial blood pressure of 80 mmHg in the groups, within 222,00 ± 79,65 sec in remifentanil group and  658,94 ± 176,64 sec in Esmolol group. The duration of hypotension was 100,33 ± 7,79 minutes in  remifentanil group and  64 ± 4,37 minutes in esmolol group. There were no difference in the mean arterial blood pressure (mmHg) values at sistolic arterial pressure of 80 mmHg between the groups. Heart rate was lower in Remifentanil group (Group R) than Esmolol group (p<0.05). Mean arterial blood pressure was lower in Remifentanil group than Esmolol group (p<0.05). There was significant decrease in Surgical Field Rating in Esmolol group for the first 20 minutes, but the maximum bleeding scores  in Esmolol group was higher than Group R for the first 60 minutes.

Conclusion: Our study showed that  remifentanil was preferable in providing good, stable and reliable surgical conditions in terms of quality of operative field  and provided convenient induced hypotension for tympanoplasty.