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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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References

1.Coursin, DB, Coursin, DB, Maccioli, GA. Dexmedetomidine. Curr Opin Crit Care 2001; 7: 221–226.CrossRefGoogle ScholarPubMed
2.Tobias, JD. Controlled hypotension in children: a critical review of available agents. Paediatr Drugs 2002; 4: 439–453.CrossRefGoogle ScholarPubMed
3.Testa, LD, Tobias, JD. Pharmacologic drugs for controlled hypotension. J Clin Anesth 1995; 7: 326–337.CrossRefGoogle ScholarPubMed
4.Degoute, CS. Controlled hypotension: a guide to drug choice. Drugs 2007; 67: 1053–1076.CrossRefGoogle ScholarPubMed
5.Degoute, CS, Dubreuil, C, Ray, MJ et al. Effects of posture, hypotension and locally applied vasoconstriction on the middle ear microcirculation in anaesthetized humans. Eur J Appl Physiol Occup Physiol 1994; 69: 414–420.CrossRefGoogle ScholarPubMed
6.Degoute, CS, Ray, MJ, Manchon, M et al. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth 2001; 48: 20–27.CrossRefGoogle ScholarPubMed
7.Amaranath, L, JrKellermeyer, WF. Tachyphylaxis to sodium nitroprusside. Anesthesiology 1976; 44: 345–348.CrossRefGoogle ScholarPubMed
8.Dal, D, Celiker, V, Ozer, E et al. Induced hypotension for tympanoplasty: a comparison of desflurane, isoflurane and sevoflurane. Eur J Anaesthesiol 2004; 21: 902–906.CrossRefGoogle ScholarPubMed
9.Degoute, CS, Ray, MJ, Gueugniaud, PY et al. Remifentanil induces consistent and sustained controlled hypotension in children during middle ear surgery. Can J Anesth 2003; 50: 270–276.CrossRefGoogle ScholarPubMed
10.Durmus, M, But, AK, Dogan, Z et al. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol 2007; 24: 447–453.CrossRefGoogle ScholarPubMed
11.Richa, F, Yazigi, A, El Hage, C et al. Dexmedetomidine : an agent for controlled hypotension in maxillo-facial surgery. Eur J Anaesthesiol 2004; 21 (Suppl 32): A–242.CrossRefGoogle Scholar
12.Manola, M, De Luca, E, Moscillo, L et al. Using remifentanil and sufentanil in functional endoscopic sinus surgery to improve surgical conditions. ORL 2005; 67: 83–86.CrossRefGoogle ScholarPubMed
13.Eberhardt, LH, Folz, BJ, Wulf, H et al. Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope 2003; 113: 1369–1373.CrossRefGoogle Scholar
14.Bhana, N, Goa, KL, McClellan, KJ. Dexmedetomidine. Drugs 2000; 59: 263–268.CrossRefGoogle ScholarPubMed
15.Bloor, BC, Ward, DS, Belleville, JP et al. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 1992; 77: 1134–1142.CrossRefGoogle ScholarPubMed
16.Scheinin, H, Karhuvaara, S, Olkkola, KT et al. Pharmacodynamics and pharmacokinetics of intramuscular dexmedetomidine. Clin Pharmacol Ther 1992; 52: 537–546.CrossRefGoogle ScholarPubMed
17.Bürkle, H, Dunbar, S, Van Aken, H. Remifentanil: a novel, short-acting, mu opioid. Anesth Analg 1996; 83: 646–651.CrossRefGoogle ScholarPubMed
18.Egan, TD, Lemmens, HJ, Fiset, P et al. The pharmacokinetics of the new short-acting opioid remifentanil (G187084B) in healthy adult male volunteers. Anesthesiology 1993; 79: 881–892.CrossRefGoogle ScholarPubMed
19.Toivonen, J, Kaukinen, S. Clonidine premedication: a useful adjunct in producing deliberate hypotension. Acta Anaesthesiol Scand 1990; 34: 653–657.CrossRefGoogle ScholarPubMed
20.Woodcock, TE, Millard, RK, Dixon, J et al. Clonidine premedication for isoflurane-induced hypotension. Sympathoadrenal responses and a computer-controlled assessment of the vapour requirement. Br J Anaesth 1988; 60: 388–394.CrossRefGoogle Scholar
21.Maze, M, Segal, IS, Bloor, BC. Clonidine and other alpha2 adrenergic agonists: strategies for the rational use of these novel anesthetic agents. J Clin Anesth 1988; 1: 146–157.CrossRefGoogle ScholarPubMed
22.Guo, T-Z, Jiang, J-Y, Buttermann, AE et al. Dexmedetomidine injection into the locus coeruleus produces antinociception. Anesthesiology 1997; 86: 1055–1060.Google Scholar
23.Bulow, NM, Barbosa, NV, Rocha, JB. Opioid consumption in total intravenous anesthesia is reduced with dexmedetomidine: a comparative study with remifentanil in gynecologic videolaparoscopic surgery. J Clin Anesth 2007; 19: 280–285.CrossRefGoogle ScholarPubMed
24.Eberhardt, LH, Eberspaecher, M, Wulf, H et al. Fast-track eligibility, costs and quality after intravenous anaesthesia with propofol-remifentanil versus balanced anaesthesia with isoflurane-alfentanil. Eur J Anaesthesiol 2004; 21: 107–114.Google Scholar