title: Comparison of the hemodynamic effects of nitroprusside and remifentanil for controlled hypotension during endoscopic sinus surgery.
abstract: OBJECTIVE
  Controlled hypotension (CH) is a well-established technique to decrease blood loss and improve surgical visibility. Although nitroprusside and remifentanil have been safely and effectively used for this purpose, the hemodynamic changes that occur during CH are unclear. This study compared the effects of nitroprusside and remifentanil on hemodynamics using a noninvasive cardiac output monitor (Cheetah NICOM(®); Cheetah Medical Inc., Maidenhead, Berkshire, UK) for endoscopic sinus surgery (ESS).
  
  
  METHODS
  Twenty-eight adult patients scheduled for ESS were randomly assigned to the nitroprusside group (n = 14) or remifentanil group (n = 14). After anesthesia induction, hypotension was induced with continuous infusion of nitroprusside or remifentanil at a target mean arterial blood pressure (MAP) of 60-70 mmHg. Cardiac index (CI), stroke volume index (SVI) and total peripheral resistance index (TPRI) were measured at 10-min intervals.
  
  
  RESULTS
  The heart rate was higher and SVI was lower in the nitroprusside group than in the remifentanil group during CH. There were no significant differences in MAP, CI or TPRI between the two groups. Both nitroprusside and remifentanil reduced MAP and TPRI during CH compared with baseline values. However, there was no significant change in CI.
  
  
  CONCLUSIONS
  Both nitroprusside and remifentanil were effective to induce CH and maintain CI during CH.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Aran 13gil 15, Jeju, Jeju Special Self-governing Province, 690-767, Republic of Korea.
authors.forename: So Hui
authors.initials: SH
authors.lastname: Yun
authors.forename: Jeong Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D002302:Cardiac Output / Q000187:drug effects; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007023:Hypotension, Controlled / Q000379:methods*; D008297:Male; D009599:Nitroprusside / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use*; D000077208:Remifentanil; D055815:Young Adult
chemical_list: D010880:Piperidines; D009599:Nitroprusside; D000077208:Remifentanil