Clinical Study Of Controlled Hypotension With Remifentanil For Functional Endoscopic Sinus Surgery

Objective To explore the feasibility of remifentanil inducing controlled hypotension for functional endoscopic sinus surgery and observe the influences on endocrine hormones. To investigate the role of PGI2 on the cardiovascular effects of remifentanil.Methods Sixty patients with ASA grade 1 or ASA grade 2 undergoing functional endoscopic sinus surgery under general anesthesia were included into the study. According the hypotensive medication patients were divided into 3 groups: sodium nitroprusside(SNP) group (abbreviating to group N), remifentanil group (group R) and remifentanil-sodium nitroprusside group (group RN). All patients were taken balanced anesthesia. After induction tracheal intubation was taken, and maintenance with isoflurane(1.0%～1.5%), morphine and repetitive atracurium. Controlled hypotension was taken to maintain MAP between 60⁷0mmHg by SNP, remifentanil or remifentanil combined with SNP. In group N, sodium nitroprusside was infused continuously starting at a dose of 1μg·kg^-1·min^-1; In group R, remifentanil was infused continuously starting at a dose of 0.2μg·kg^-1·min^-1; in group RN, if the ceiling effect of remifentanil occurred and MAP could not reach the target level, sodium nitroprusside was supplemented starting at a dose of 0.1μg·kg^-1·min^-1. SNP or remifentanil was titrated to obtain the predetermined BP. Quality of the surgical field and patients'consciousness of...