Hanci Ayşe, Karahan Tuncay, Sivrikaya G Ulufer, Başgül Ayda, Coşkun Berna Uslu
Department of Anesthesiology and Reanimation, Sişli Etfal Training and Research Hospital, Istanbul, Turkey.
Kulak Burun Bogaz Ihtis Derg. 2007;17(6):311-7.
We compared the efficacy of remifentanil and the combination of alfentanil and sodium nitroprusside on controlled hypotension and bleeding at surgical site.
Thirty ASA I-II patients undergoing tympanoplasty were randomly assigned to remifentanil and alfentanil-sodium nitroprusside groups, equal in number. Anesthesia was induced with remifentanil or alfentanil combined with propofol and rocuronium, and maintained with remifentanil or alfentanil-sodium nitroprusside infusions combined with propofol. All patients were ventilated with a mixture of 33% O2 and 66% N2O. Invasive mean arterial blood pressure, heart rate, peripheral oxygen saturation, the amount of bleeding at surgical site, and blood gas values were recorded.
Controlled hypotension was achieved at a target mean arterial pressure of 60+/-5 mmHg in both groups. Compared to the baseline levels, heart rate values were lower in the remifentanil group (p<0.05), and similar in the sodium nitroprusside group (p>0.05). The amount of bleeding and the dryness of the surgical site were similar in two groups. PaCO2 and pH values differed significantly between the two groups at perioperative 1 and 2 hours and in the postoperative 30th minute (p<0.05), but the difference was not clinically significant.
Our results suggest that remifentanil is effective in obtaining controlled hypotension without an additional potent hypotensive agent and provides appropriate surgical conditions by reducing the amount of bleeding.
我们比较了瑞芬太尼以及阿芬太尼与硝普钠联合使用在控制低血压及减少手术部位出血方面的疗效。
30例美国麻醉医师协会（ASA）分级为I-II级的行鼓室成形术患者被随机分为瑞芬太尼组和阿芬太尼-硝普钠组，每组人数相等。分别用瑞芬太尼或阿芬太尼联合丙泊酚及罗库溴铵诱导麻醉，并用瑞芬太尼或阿芬太尼-硝普钠输注联合丙泊酚维持麻醉。所有患者均采用33%氧气和66%氧化亚氮的混合气体通气。记录有创平均动脉压、心率、外周血氧饱和度、手术部位出血量及血气值。
两组均在目标平均动脉压60±5 mmHg时实现了控制性低血压。与基线水平相比，瑞芬太尼组心率值较低（p<0.05），硝普钠组心率值相似（p>0.05）。两组手术部位出血量及干燥程度相似。两组在围手术期1小时、2小时及术后30分钟时的动脉血二氧化碳分压（PaCO2）和pH值有显著差异（p<0.05），但差异无临床意义。
我们的结果表明，瑞芬太尼在无需额外强效降压药的情况下有效实现控制性低血压，并通过减少出血量提供了合适的手术条件。
