The application of controlled hypotension with remifentanil in nasal endoscopic surgery
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Objective To study the efficacy and safety of sodium nitroprusside(SNP) with remifentanil used for controlled hypotension in nasal endoscopic surgery.Methods Sixty children undergoing operation were randomly divided into A and B group.Local anesthesia was in A group;Anesthesia was maintained with the continuous infusion of remifentanil and propofol in B group.Controlled hypotension was performed and the MAP was reduced and maintained between 60~70 mmHg with the continuous infusion of SNP.Hemodynamic changes before operation,in operation and 10 min after operation were observed.Results Data in B groups showed high satisfaction with hypotension,HR was stability in B group.Hemodynamic changes were better in B group than in A group(P0.05).Conclusions Remifentanil could potentiate the hypotensive effect of SNP,decrease the bleeding amount,shorten the operation time and maintain a stable hemodynamics during controlled hypotension.Keywords:
Sodium nitroprusside
Target controlled infusion
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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.
Esmolol
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Objective:To compare the clinical effects of anesthetic controlling hypotension and vasodilator controlling hypotension in endoscopic sinus surgery.Methods:50 patients undergoing selective endoscopic sinus surgery without surgical contraindications were randomized into two groups,25 cases per group.The group R was performed the anesthetic controlling hypotension with propofol combined remifentanil and the group S received vasodilator controlling hypotension with sodium nitroprusside.Results:There were no significant differences between R group and S group on the parameters of hypotension inducing time,hypotension period,blood pressure recovering time,MAP and HR at various time points(P0.05).The scores of surgical field at all time points had no significant difference except a time point of 40min(P0.05).Significant decrease of total operation time,total bleeding volume and adverse reaction rate were observed in the group R compared with the group S(P0.05).Conclusion:Utilizing anesthetic controlling hypotension with combining remifentanil and propofol can effectively control the blood pressure,decrease intraoperative bleeding and obtain the better surgical field scores in endoscopic sinus surgery with satisfactory clinical effects.
Endoscopic sinus surgery
Mean arterial pressure
Sodium nitroprusside
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서 론유도 저혈압은 Gardner가 1) 수술 중 유도 저혈압을 시행함 으로써 출혈량을 감소시킬 수 있었다고 보고한 후 임상적 으로 널리 사용되기 시작하였으며, 최근에는 악안면 수술, 척추 수술, 고관절 수술 등 실혈량이 많을 것으로 예상되는 경우 수술 중 출혈량을 감소시키고 그로 인해 수술 시야가 개선되어 수술의 정확성을 기할 수 있어 종종 사용된다.유 도 저혈압에 사용하는 약제로는 sodium nitroprusside
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Objective To observe the clinical effect of controlled-hypotension by comhination of Remifentanil and Sevoflurane in patients undergoing spinal surgery.Mtthoda 40 cases of ASA Ⅰ～Ⅱpatients who received surgery spinal surgery were chosen,and randomized into two groups:Remifentanil group(Ⅰ group)and Glonoine group(Ⅱ group),each 20 people.All patients received endotracheal anesthesia and inhale Sevoflurane to maintain the anesthesia.Implemented the controlled-hypotension before skin exciding,adjusted the dosage of Remifentanil and Glonoine and maintain the MABP[mean arterial blood pressure)at 60～65mmHg during the operation,and stop the controlled-hypotension at the end of the operations.Recorded the two group's MAP,HR,CVP,the number of spinal segment,operation time,the amount of surgical bleeding,and the time of vivification.Results two groups'patient can achieve the MAP target after implementing the controlled-hypotension.The HR slowed down in Ⅰ group and increased in Ⅱgroup during the time of controlled-hypotension.Two groups'CVP were lower than the baseline,and the Ⅱgroup were lower than the Ⅰ group.After stopping controlled-hypotension,the BP get back to the baseline10min later in the Ⅰ group,while it still lower than the baseline in the Ⅱ group 20min later.Conclusion The controlled-hypotension by combination of Remifentanil and Sevoflurane in patients undergoing spinal surgery has good results.In compare with Glonoine,the Remifentanil has the advantage of less bleeding and rapid BP recovery.
Key words:
Spinal surgery; Controlled-hypotension; Remifentanil; Sevoflurane; Glonoine
Mean arterial pressure
Spinal Surgery
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Objective:To compare the effects of remifentanil and nitroglycerin for deliberate hypotension in patients during endoscopic sinus surgery.Methods:60 patients undergoing endoscopic sinus surgery were randomly devided into group R and group N.Patients in group R were infused with remifentanil 0.1～0.5 μg/(kg·min) and patients in group N were infused with nitroglycerin 0.5～3 μg/(kg·min).The target of deliberate hypotension was fixed at MAP 60～65 mm Hg,which was maintained for 60 minutes.The hemodynamic changes in two groups were recorded and amount of blood loss,extubation time were also compared.Results:The patients in both groups could maintain MAP at the target of deliberate hypotension,There was no significant difference between two groups(P0.05).HR was significant reduced in R group compared with that before(P0.05) and was significant increased in N group(P0.05).The amount of blood loss and extubation time were no any significant difference between two groups.Conclusion:Deliberate hypotension with remifentanil is effective and safe with less influence on cardiac function in patients undergoing endoscopic sinus surgery.
Endoscopic sinus surgery
Nitroglycerin (drug)
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Objective:To evaluate the effect of continuous infusion of remifentanil on controlled hypotension in nasal endoscopic surgery.Methods:50 cases undergoing selective nasal endoscopic surgery were random-ly divided into group A(remifentanil group) and group B(sodium nitroprusside group),and the hemody-namic changes of two groups were compared.Results:There were no not significant different in the systolic blood pressure and mean arterial blood pressure between two groups(P 0.05).The heart rate of group A was significantly lower than group B(P 0.05).Conclusion: The continuous infusion of remifentanil had ideal antihypertensive effect in nasal endoscopic surgery,is feasible and safe.
Sodium nitroprusside
Mean arterial pressure
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Objective To investigate the effects,safety,controlling of controlled hypotension induced by remifentanil during endoscopic sinus surgery.Methods Forty patients with ASA grade Ⅰ～Ⅱ undergoing selective endoscopic sinus surgery,were randomly assigned into remifentanil group(A group)and nitroglycerin group(B group).After routine inducing,controlled hypotension was induced before the main procedure of surgery.A group was given remifentanil(1μg/kg)by intravenous injection,then remifentanil(0.3～0.8μg·kg~(-1)·min~(-1))was used in group A to keep mean arterial pressure between(MAP)60 and 80 mm Hg.B group was given fentanyl(0.03～0.08 μg·kg~(-1)·min~(-1))and nitroglycerin(2～5 μg·kg~(-1)·min~(-1))to keep mean arterial pressure(MAP)between 60 to 80 mm Hg till the main procedure of surgery was finished.Observing MAP and HR change before controlled hypotension,during controlled hypoteusion and after stopping controlled hypotension.Observing the time of opening-eyes,remove-tracheal tube and surgical field quality.Results The two groups were comparable with regard to the surgical field rating(P＞0.05).MAP in two groups during controlled hypotension were lower than those before controlled hypotension(P＜0.05),in A group,MAP were comparable with those in B group during controlled hypotension(P＞0.05).In B group there was rellexible tachycardia during controlled hypotension.HR in A group during controlled hypotension was lower than those before controlled hypotension(P＜0.05).HR during controlled hypotension in A group was lower than those in B group(P＜0.01).The time of opening-eyes,remove-tracheal tube in A group was less than those in B group(P＜0.01).ConclusionRemifentanil cound induce and sustain controlled hypoteusion.It was safe and feasible.It was better than nitroglycerin group for controlled hypotension in endoscopic sinus surgery.
Key words:
fentanil; hypotension controlled
Mean arterial pressure
Endoscopic sinus surgery
Group B
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Objective:To investigate the clinical efficacy of deliberate hypotension with remifentanil in endovascular treatment of intracranial aneurysms.Methods:A total of 30 cases of intracranial aneurysms,were divided according to the condition of combined with hypertension,into control group(Group C) and hypertension group(Group H),each with 15 cases.Two groups adopted induction of anesthesia in patients with intravenous propofol 1.5～2mg/kg,remifentanil 1μg/kg,vecuronium 0.1mg/kg.Maintenance of anesthesia:propofol 3~5mg/(kg·h) and remifentanil 0.2～0.4μg/(kg·min),and intermittent intravenous injection of vecuronium 0.06mg/kg maintained muscle relaxation.When controlled hypotension was needed,the infusion of remifentanil to accelerated 0.8μg/(kg·min).Heart rate and blood pressure were recorded at baseline,after anesthesia induction,on tracheal intubation,before intracranial aneurysm embolism,after intracranial aneurysm embolism and extubation.Results:After induction of anesthesia,there were obvious decline in blood pressure and heart rate in both group(P0.05).The BP and HR of Group C were stable in the whole progress of operation,while BP Group H often increased before intracranial aneurysm embolism and needed controlled hypotension with sodium nitroprusside and incidence of hypertension was higher than that of N group(P0.05).Conclusion:Controlled hypotension with remifentanil was safe and pratical for non-hypertension patients,but it was not enough only with remifentanil for hypertension patients,which needed other drug such as sodium nitroprusside.
Sodium nitroprusside
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Objective To study the effects of different anesthesia drugs on hypotension used for controlled hypotension in nasal endoscopic surgery. Methods Sixty patients undergoing nasal endoscopic surgery were randomly divided into A group (fentanyl and sodium nitroprusside group) and B group (remifentanil and sodium nitroprusside group). Anesthesia was maintained with the continuous infusion of either fentanyl in A group or remifentanil in B group. Controlled hypotension was performed and the MAP was reduced and maintained between 60～ 70 mmHg with the continuous infusion of SNP. Hemodynamic changes before hypotension,at the time of reaching aim,5～ 60 min during hypotension and 5～ 10 min after discontinuing hypotension,recovery profile of anesthesia,and adverse reactions were observed. Results Data in 2 groups showed high satisfaction with hypotension,HR and the dose of SNP were increased significantly in A group than B group (P 0.05). Hemodynamic changes,the time to opening eyes on commond and recovery from anesthesia were better in B group than in A group(P 0.05). Conclusions Remifentanil could potentiate the hypotensive effect of SNP,decrease the doses of SNP and maintain a stable hemodynamics during controlled hypotension. The depth of anesthetic was controlled easily and recovery from anesthesia is faster.
Sodium nitroprusside
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Objective: To study the application of controlled hypotension by target-controlled infusion of remifentanil combined with propofol in spinal surgery.Methods:A total of 66 patients schedulled for spinal surgery from June 2009 to November 2011 were selected,and were randomly divided into control group and observation group with 33 cases in each group.Patients in control group were given by fentanyl combined with propofol,and the observation group were given target-controlled infusion of remifentanil combined with propofol.MAP,PgCO2,HR,CI,recovery quality,and blood loss before and 10,30,60 min after antihypertensive treatment,and 10 min after drug withdrawal were observed and compared.Results:After treatment,MAP,PgCO2,HR,CI and blood loss in observation group were significantly lower than those of control group,restoration status and recovery quality after withdrawal was better than those of control group(P0.05).Conclusions:The target-controlled infusion by remifentanil combined with propofol is effective on treating controlled hypotension patients undergoing spinal operation,and is of little influence on heart and respiratory system.
Target controlled infusion
Spinal Surgery
Continuous Infusion
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