title: Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty.
abstract: BACKGROUND
  This randomized, double-blind study was designed to assess the effect of perioperative remifentanil with controlled hypotension on intraoperative bleeding, postoperative edema, and ecchymosis.
  
  
  METHODS
  Fifty-two patients undergoing rhinoplasty were divided into 2 groups. The remifentanil group received 1 µg · kg(-1) intravenously as a bolus before induction of anesthesia, 0.5 to 1 µg · kg(-1) · h(-1) by continuous intravenous infusion during the operation. After anesthesia induction with propofol (2-3 mg · kg(-1)) and fentanyl (1-15 µg · kg(-1)), muscle relaxation was achieved with rocuronium (0.45-0.90 mg · kg(-1)). Mean arterial pressure was maintained at 50 to 60 mm Hg in controlled hypotensive anesthesia achieved using remifentanil infusion. Perioperative hemodynamics and bleeding; early postoperative pain and agitation scale; postoperative first, third, and seventh day edema; and ecchymosis were evaluated. Edema and ecchymosis were evaluated using graded scale from 0 to 4.
  
  
  RESULTS
  Remifentanil reduced mean arterial pressure during the entire operative period and the first 30 minutes postoperatively (P < 0.05 for these comparisons). Intraoperative bleeding also decreased (P < 0.001). There was a significant decrease in edema in both upper and lower eyelid edema on the first and third days in the remifentanil group, although this difference was not detected on the seventh day (P(1upper) = 0.000, P(1lower) = 0.000, P(3upper) = 0.008, and P(3lower) = 0.002). Ecchymosis decreased significantly in both upper and lower eyelids on the first, third, and seventh days in the remifentanil group (P(1upper) = 0.000, P(3upper) = 0.000, P(3upper) = 0.002, P(3lower) = 0.002, P(7upper) = 0.049, and P(7lower) = 0.038). There were no differences in postoperative pain and agitation between 2 groups.
  
  
  CONCLUSIONS
  Remifentanil with controlled hypotension may reduce edema and ecchymosis of the upper and lower eyelids, by reducing mean arterial pressure and amount of bleeding in rhinoplasty.
authors: From the Departments of *Anesthesiology, †Plastic and Aesthetic Surgery, and ‡Public Health, Medical School of Karadeniz Technical University, Trabzon, Turkey.
authors: Müge
authors: M
authors: Koşucu
authors: Sahin
authors: S
authors: Omür
authors: Ahmet
authors: A
authors: Beşir
authors: Muhammet
authors: M
authors: Uraloğlu
authors: Murat
authors: M
authors: Topbaş
authors: Murat
authors: M
authors: Livaoğlu
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001794:Blood Pressure / Q000502:physiology; D004311:Double-Blind Method; D004438:Ecchymosis / Q000517:prevention & control*; D004487:Edema / Q000517:prevention & control*; D005141:Eyelid Diseases / Q000517:prevention & control; D005260:Female; D006801:Humans; D007023:Hypotension, Controlled; D008297:Male; D010880:Piperidines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D000077208:Remifentanil; D012225:Rhinoplasty / Q000379:methods*; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D000959:Antihypertensive Agents; D010880:Piperidines; D000077208:Remifentanil