Induced Hypotension for Nasal Surgery: Remifentanil versus Esmolol

Abstract

Objectives:

Compare the efficiency and safety of using remifentanil versus esmolol infusion for induction and maintenance of controlled hypotension. The study evaluates this effect on the quality and dryness of the operative field in endoscopic sinus surgery (FESS). Design: Prospective, randomized, patient- and observer-blinded study.

Methods:

Thirty patients undergoing FESS were randomly assigned to receive either remifentanil or esmolol for inducing controlled hypotension. The same surgeon blinded to the hypotensive agent used and hemodynamic variables performed all operations. He used a six point scale of 0-5 to assess the surgical field (0= bloodless and 5= uncontrolled bleeding).

Results:

Controlled hypotension was achieved at the target mean pressure of 50-55 mmHg for both remifentanil and esmolol groups. There were no statistical differences between the groups in duration of anesthesia, duration of hypotension, hemodynamic changes, or PaCo2 or PaO2 measurements. Category scale values for surgical conditions were ideal in both groups: 2.61±0.32 in the remifentanil group and 2.48±0.21 in the esmolol group, with no significant difference between the two groups.

Conclusions:

Both remifentanil and esmolol infusion provide consistent and sustained controlled hypotension, and both are effective in providing a dry surgical field during functional endoscopic sinus surgery.