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Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty

Published online by Cambridge University Press:  01 May 2008

F. Richa ,
A. Yazigi ,
G. Sleilaty  and
P. Yazbeck
F. Richa*
Affiliation:
Saint-Joseph University, Hotel-Dieu de France Hospital, Department of Anesthesia and Intensive Care, Beirut, Lebanon
A. Yazigi
Affiliation:
Saint-Joseph University, Hotel-Dieu de France Hospital, Department of Anesthesia and Intensive Care, Beirut, Lebanon
G. Sleilaty
Affiliation:
Saint-Joseph University, Hotel-Dieu de France Hospital, Department of Anesthesia and Intensive Care, Beirut, Lebanon
P. Yazbeck
Affiliation:
Saint-Joseph University, Hotel-Dieu de France Hospital, Department of Anesthesia and Intensive Care, Beirut, Lebanon
*
Correspondence to: Freda Richa, Anesthesia and Intensive Care Department, Hotel-Dieu de France Hospital, Alfred Naccache street, Ashrafieh, Beirut 166830, Lebanon. E-mails: fredrich24@yahoo.com, fredrich8@hotmail.com; Tel: +961 3 872077; Fax: +961 1 615295
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Summary

Background and objective

Controlled hypotension is frequently used for obtaining better exposure during tympanoplasty. The aim of this study was to compare dexmedetomidine, a selective, short-acting, central α2-adrenergic agonist with remifentanil, an ultra-short-acting opioid with properties similar to other μ-specific agonists, regarding their effects in achieving controlled hypotension and improving surgical field exposure and surgeon’s satisfaction during tympanoplasty.

Methods

In this prospective, double-blind pilot study, 24 consecutive patients scheduled for elective tympanoplasty were randomly assigned to receive either dexmedetomidine 1 μg kg−1 over 10 min at anaesthesia induction followed by 0.4–0.8 μg kg−1 h−1 infusion during maintenance or remifentanil 1 μg kg−1 over 1 min at anaesthesia induction followed by 0.2–0.4 μg kg−1 min−1 infusion during maintenance. Mean arterial pressure and heart rate were recorded before induction, at incision, 30, 60, 90 and 120 min after incision and 10 min after stopping the infusion. Surgical field exposure condition and satisfaction scores were assessed by the surgeon, blinded to the study drugs.

Results

Mean arterial pressure and heart rate were significantly lower in the remifentanil group compared with the dexmedetomidine group at all times (P = 0.03 and 0.036, respectively). Surgical field exposure condition (3 ± 0.01 vs. 2.3 ± 0.7; P = 0.039) and surgeons’ satisfaction (3 ± 0.01 vs. 2.25 ± 0.87; P = 0.039) scores were significant after remifentanil compared with dexmedetomidine.

Conclusions

Infusion of dexmedetomidine, at the doses used in this study, was less effective than remifentanil in achieving controlled hypotension, good surgical field exposure condition and surgeons’ satisfaction during tympanoplasty.

Keywords

DEXMEDETOMIDINEREMIFENTANILHYPOTENSION, controlledSURGERY, tympanoplasty
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 5 , May 2008 , pp. 369 - 374
Copyright
Copyright © European Society of Anaesthesiology 2008

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