Comparison Of Remifentanil And Fentanyl In Patients Undergoing Deliberate Hypotension For Endoscopic S Inus Surgery

OBJECTIVE We sought to compare effects of remifentanil versus fentanyl-based anesthesia for functional endoscopic sinus surgery and de liberate hypotension on hemodynamic changes and speed of recovery from anesthesia. METHODS Forty-four normotensive, ASA physical status I—IIpatients(30 men and 14 women),who undergoing endoscopic sinus surgery and requiring intraoperative deliberate hypotension, were randomized into two groups.In group I, anesthesia was induced with propofol and midazolam and supplemented by remifentanil and vecuronium, and maint ained with isoflurane and remifentanil. In group II,anesthesia was in duced with propofol and midazolam and Supplemented by fentanyl and ve curonium, and maintained with isoflurane and fentanyl. During surgery, patients of two groups were recieved nitroglycerin to induce deliberate hypotension. The variables compared included perioperative hemdynamic changes, the interval from the end of anesthesia to verbal commands and extubation, intraoperative nitroglycerin dosing, and changes in plasma glucose. RESULTS The two groups were matched for demographies, AS A physical status, and duration of deliberate hypotension. Perioperati ve plasma glucose changes were similar.The remifentanil-based anesthesia resulted in less respone to noxious stimulation during the stressful periods such as the induction/intubation, deliberate hypotension, extubtion and recovery phases and less amount of nitroglycerin admini stered during deliberate hypotension.There were significant differenc es between the groups in time intervals from the end of anesthesia toexbutation and ability to follow verbal commands,with the remifentanil group showing earlier recovery than the fentanyl group.Moreover,within groups, intersubject variability(as indicated by SD from the meantime to following verbal commands and extubation of trachea) was more in the fentanyl group. CONCIUSION Both remifentanil and fentanyl-based anesthesia were satisfactory with respect to endoscopic sinus surgery and deliberate hypotension. Remifentanil reduced amount of nitroglycerin administered during deliberate hypotension. Remifentanil offered superior intraoperative hemodynamic stability and quicker recovery from anesthesia in comparison with fentanyl.