Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

Abstract

Objective:This study aimed to compare two methods of controlled hypotension using labetalol and remifentanil in terms of capability to create controlled hypotension and to investigate the obtained complications, and satisfaction rate of surgeon and patient during functional endoscopic sinus surgery.Methods:In this prospective clinical trial, 62 patients underwent endoscopic sinus surgery in Al-Zahra and Ayatollah Kashani Hospitals of Isfahan were divided into two groups: in the first group, 20 mg bolus dose of labetalol and then infusion of it, at a rate of 0.5–2.0 mg/min and in the second group, remifentanil with dose of 0.5–1 μg/kg started and then 0.25–0.5 μg/kg/min were prescribed. Hemodynamic parameters during anesthesia and recovery time, surgeon and patient satisfaction, and recovery time were measured and recorded.Findings:Hemodynamics variable were comparable between two groups at different times of the study. The mean of bleeding and the frequency of side effects were higher in labetalol group (P = 0.033 and P < 0.0001, respectively). The median of surgeon satisfaction score in remifentanil group was statistically higher in labetalol group (P < 0.0001). Recovery time, fluid requirement, and pain score in labetalol group reported significantly more than remifentanil group. Richmond Agitation–Sedation Scale status at time points in the postanesthetic care unit showed differences between groups.Conclusion:With infusion of labetalol and remifentanil after a bolus dose we can induce effective controlled hypotension under general anesthesia. Remifentanil is a short-acting narcotic drug; then, patient satisfaction was better and recovery time was shorter. From the economic aspect, labetalol prefers to remifentanil.

Efficacy and Safety of Propofol combined with different doses of Remifentanil for gastroscopy: A-randomized controlled trial

“…In this study, propofol combined with remifentanil for painless gastroscopy was shown to reduce the dosage of propofol and shorten the onset and recovery time, which was consistent with the results of previous studies [13][14] . In addition, our research found the combination of 2.5 mg/ml (PR2) and 5 mg/ml (PR3) of remifentanil with propofol signi cantly reduced the onset time and recovery time, as well as the dosage of propofol, compared with the combination of 1.25 mg/ml (PR1) of remifentanil with propofol.…”

Effects of remifentanil with or without midazolam pretreatment on the 95% effective dose of propofol for loss of consciousness during induction

“…Remifentanil is often used to induce hypotension during surgery. [ 18 , 19 ] The decrease in blood pressure is thought to be due to a decrease in the regional vascular tone. [ 20 ] However, remifentanil is known for better maintenance of hemodynamic stability and the cerebral blood flow compared with other currently used opioids, [ 21 ] although the decrease in blood pressure becomes more conspicuous when it is administered in combination with propofol.…”

Comparing Labetalol and Nitroglycerine on Inducing Controlled Hypotension and Intraoperative Blood Loss in Rhinoplasty: A Single-Blinded Clinical Trial

“…An example of such was Nagat S. et al ( 13 ) that, similar to the current study, utilized labetalol and TNG to induce controlled hypotension in sinus endoscopy operations and deduced that both drugs were effective and safe, but labetalol was introduced superior as it improved the visualization of surgical field with a lower (and safer) levels of hypotension; and also a lower level of hemorrhage with labetalol in the current study was due to less tachycardia in comparison to TNG. In another study by Sajedi et al, ( 14 ) regarding a comparison of labetalol and remifentanil administration to induce controlled hypotension while performing a sinus endoscopy, the authors concluded that despite the similarity of hemodynamic variables in both studied groups, a higher measure of hemorrhage and other complications were recorded in the labetalol group. Also, surgeons were more satisfied with the operation field conditions, while using remifentanil compared to labetalol; a result nearly similar to that of the current study.…”