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Effect of a balanced anaesthetic technique using desflurane and remifentanil on surgical conditions during microscopic and endoscopic sinus surgery.
Rhinology. 2007 Mar; 45(1):72-8.R

Abstract

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+Show Affiliations

Department of Anaesthesiology and Critical Care Medicine, Philipps-University of Marburg, Germany. eberhart@mailer.uni-marburg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

17432075

Citation

Eberhart, L H J., et al. "Effect of a Balanced Anaesthetic Technique Using Desflurane and Remifentanil On Surgical Conditions During Microscopic and Endoscopic Sinus Surgery." Rhinology, vol. 45, no. 1, 2007, pp. 72-8.
Eberhart LH, Kussin A, Arndt C, et al. Effect of a balanced anaesthetic technique using desflurane and remifentanil on surgical conditions during microscopic and endoscopic sinus surgery. Rhinology. 2007;45(1):72-8.
Eberhart, L. H., Kussin, A., Arndt, C., Lange, H., Folz, B. J., Werner, J. A., Wulf, H., & Kill, C. (2007). Effect of a balanced anaesthetic technique using desflurane and remifentanil on surgical conditions during microscopic and endoscopic sinus surgery. Rhinology, 45(1), 72-8.
Eberhart LH, et al. Effect of a Balanced Anaesthetic Technique Using Desflurane and Remifentanil On Surgical Conditions During Microscopic and Endoscopic Sinus Surgery. Rhinology. 2007;45(1):72-8. PubMed PMID: 17432075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of a balanced anaesthetic technique using desflurane and remifentanil on surgical conditions during microscopic and endoscopic sinus surgery. AU - Eberhart,L H J, AU - Kussin,A, AU - Arndt,C, AU - Lange,H, AU - Folz,B J, AU - Werner,J A, AU - Wulf,H, AU - Kill,C, PY - 2007/4/17/pubmed PY - 2007/7/10/medline PY - 2007/4/17/entrez SP - 72 EP - 8 JF - Rhinology JO - Rhinology VL - 45 IS - 1 N2 - 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. SN - 0300-0729 UR - https://www.unboundmedicine.com/medline/citation/17432075/Effect_of_a_balanced_anaesthetic_technique_using_desflurane_and_remifentanil_on_surgical_conditions_during_microscopic_and_endoscopic_sinus_surgery_ L2 - https://www.rhinologyjournal.com/Abstract.php?id=610 DB - PRIME DP - Unbound Medicine ER -