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The Utility of Remifentanil Compared with Nitroglycerin for Deliberate Hypotensive Anaesthesia throughout Tympanoplasty. Randomized and Observer-Blinded Clinical Trial

Abstract

Nagat S. EL-Shmaa, Ashraf E Alzeftawy and Ahmed Younes

Background: The purpose of this randomized observer-blinded clinical trial was to evaluate the utility of remifentanil compared with nitroglycerin for deliberate hypotensive anaesthesia throughout tympanoplasty.

Methods: Patients planned for elective typanoplasty under general anaesthesia were allocated to receive either intravenous infusion of nitroglycerin 2-5 μg/kg/min (group NTG), or remifentanil 0.2-0.5 μg /kg/min (group REMI). The primary outcome measures were to keep up MAP between 60 and 70 mmHg with ideal vision of operative site.

Results: Both studied agents induced deliberate hypotensive anaesthesia and achieved ideal vision of the surgical site by decreasing bleeding, but optimum vision was provided at reasonable hypotension (MAP 70-75) in group REMI however similar situation was provided at MAP 65–69 mmHg in group NTG.

Conclusion: Remifentanil and nitroglycerin are safe, efficient and might be advisable for deliberate hypotensive anaesthesia throughout tympanoplasty. However, remifentanil was superior as it provided optimum vision of the surgical site through decreasing intra operative bleeding with reasonable reduction in MAP, and mild tachycardia throughout tympanoplasty.