title: Hypotensive anaesthesia with remifentanil combined with desflurane or isoflurane in tympanoplasty or endoscopic sinus surgery: a randomised, controlled trial.
abstract: OBJECTIVE
  To compare the effect of remifentanil combined with desflurane or isoflurane on the quality of the operative field and surgical conditions, blood loss, and recovery during tympanoplasty or endoscopic sinus surgery.
  
  
  METHODS
  Randomised, double-blinded clinical study.
  
  
  METHODS
  Sixty-four patients were scheduled for elective tympanoplasty or endoscopic sinus surgery. The patients were randomly divided into two groups: desflurane or isoflurane. After anaesthesia induction, all patients received a continuous remifentanil infusion of 0.2-0.5 microg/kg/min until a mean arterial pressure of 65-75 mmHg was achieved. Heart rate and mean arterial pressure were recorded throughout anaesthesia. Blood loss was measured at the end of surgery. Achievement of a bloodless operative field was rated on a 100 mm visual analogue scale. Following completion of surgery, the time to extubation and to achievement of an Aldrete score of nine or more was recorded.
  
  
  RESULTS
  Sixty-three patients were evaluated. The total dose of remifentanil and the total blood loss were similar in both groups (p > 0.05). Time to extubation and to an Aldrete score of nine or more for the desflurane group was significantly less than for the isoflurane group (p 0.05).
  
  
  CONCLUSIONS
  Although desflurane and isoflurane both enabled good surgical conditions (in terms of quality of operative field) and convenient induction of hypotension for tympanoplasty and endoscopic sinus surgery, the recovery characteristics of desflurane were better than those of isoflurane. Therefore, desflurane may be preferable to isoflurane in such circumstances.
authors.affiliation: Department of Anaesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey. kaygusuzkenan@gmail.com
authors.forename: K
authors.initials: K
authors.lastname: Kaygusuz
authors.forename: A
authors.initials: A
authors.lastname: Yildirim
authors.forename: I Ozdemir
authors.initials: IO
authors.lastname: Kol
authors.forename: S
authors.initials: S
authors.lastname: Gursoy
authors.forename: C
authors.initials: C
authors.lastname: Mimaroglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000494:pharmacology*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D000077335:Desflurane; D004311:Double-Blind Method; D004724:Endoscopy / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery*; D010880:Piperidines / Q000494:pharmacology*; D000077208:Remifentanil; D012852:Sinusitis / Q000601:surgery*; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods
chemical_list: D019162:Anesthetics, Combined; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil