Document Detail


Effect of a balanced anaesthetic technique using desflurane and remifentanil on surgical conditions during microscopic and endoscopic sinus surgery.
MedLine Citation:
PMID:  17432075     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Controlled hypotension is used to improve surgical conditions during microscopic and endoscopic sinus surgery. Several drug combinations are suitable to provide deep and predictable level of anaesthesia combined with an exact control of intraoperative blood pressure. However, only little is known about the relative importance of the level of hypnosis on the one hand and analgesia on the other hand. STUDY DESIGN: Prospective, randomized, patient and observer-blinded study. METHODS: All 100 consecutive patients received a balanced anaesthesia technique using desflurane and remifentanil. Anaesthesia was desflurane-accentuated with remifentanil-supplementation (DARS-group: 1 MAC desflurane; remifentanil: 0.2 microg x kg(-1) x min(-1)) or remifentanil-accentuated with desflurane-supplementation (RADS-group: desflurane: 0.5 MAC; remifentanil: 0.4 microg x kg(-1) x min(-1)). Administration of anaesthetics performed to maintain a sufficient level of anaesthesia and to keep mean arterial pressure between 60 and 70 mmHg (8-9.3 hPa). The attending ENT-surgeons were unaware of the type of anaesthesia and rated general surgical conditions and the dryness of the operating site on a visual analogue scale (0-10 cm) and on a verbal rating scale immediately after surgery. RESULTS: Blood pressure and heart rate was not different between the two groups. Dryness of the operating site was rated significantly better (p < 0.0001) in the DARS-group (median; 25th/75th-percentile: 2.0; 1.5-3.5 vs. RADS-group: 2.6; 2.0-4.0) but the overall rating of the surgical conditions did not differ between the groups (DARS-group: 2.0; 1.0-2.4 vs. RADS-group: 2.2; 1.5-3.2). Immediate postoperative recovery times were increased in the RADS-group, but there was no difference with respect to fit-for-discharge criteria one hour after surgery. CONCLUSION: Balanced anaesthesia using high dose of desflurane offers small but statistically significant advantages with respect to dryness of the operating site compared to an opioid-accentuated anaesthesia technique. However, since the opioid-accentuated anaesthetic group had a faster immediate recovery both techniques are equally effective for microscopic and endoscopic sinus surgery.
Authors:
L H J Eberhart; A Kussin; C Arndt; H Lange; B J Folz; J A Werner; H Wulf; C Kill
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Rhinology     Volume:  45     ISSN:  0300-0729     ISO Abbreviation:  Rhinology     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-04-13     Completed Date:  2007-07-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0347242     Medline TA:  Rhinology     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  72-8     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology and Critical Care Medicine, Philipps-University of Marburg, Germany. eberhart@mailer.uni-marburg.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia Recovery Period
Anesthetics, Combined / administration & dosage*
Anesthetics, Inhalation / administration & dosage*
Anesthetics, Intravenous / administration & dosage*
Blood Loss, Surgical / prevention & control
Blood Pressure / drug effects
Electroencephalography / drug effects
Endoscopy / methods*
Female
Heart Rate / drug effects
Humans
Hypotension, Controlled
Intraoperative Care
Isoflurane / administration & dosage,  analogs & derivatives*
Male
Microsurgery / methods*
Middle Aged
Patient Discharge
Piperidines / administration & dosage*
Prospective Studies
Single-Blind Method
Sinusitis / surgery*
Chemical
Reg. No./Substance:
0/Anesthetics, Combined; 0/Anesthetics, Inhalation; 0/Anesthetics, Intravenous; 0/Piperidines; 132875-61-7/remifentanil; 26675-46-7/Isoflurane; 57041-67-5/desflurane

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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