Controlled hypotension during middle ear surgery: hemodynamic effects of remifentanil vs nitroglycerin

INTRODUCTION: Controlled hypotension is a well-known technique used by anesthesiologists to limit intraoperative bleeding in patients undergoing middle ear surgery and improve visibility of the surgical field. Nitroglycerin and remifentanil are among the drugs used to induce contro lled hypotension.The aim of our study was to compare the hemodynamic effects of remifentanil and nitroglycerin in this patient pop ulation. METHODS: All consecutive patients who underwent midd le ear surgery between January and December 2016, at the University Hospital Vittorio Emanuele in Cata nia were included in a retrospective study. Patients who were given nitroglycerin to induce controlled hypotension were compared to those given remifentanil. The following parameters were measured systolic and diastolic blood pressure, heart rate, perip heral (capillary) oxygen saturation, and fraction of expired carbon dioxide. A mean arterial pressure of 50-70 mmHg was considered optimal. RESULTS: Thirty pa tients who underwent stapedioplasty and tympanoplasty, 25 men and 5 women,with a mean age of 43 years (range 32-58 years) were included in the study. Fifteen patients had received nitroglycerin (group A) and 15 patients remifentanil (group B). The target blood pr essure was reached in all patients and no significant difference was found between the groups with regard to the level of systolic and diastolic blood pressure, heart rate, peripheral (capillary) oxygen saturation, and fraction of expired carbon dioxid e. However the heart rate of 2 younger patients in group A rose to > 100 bpm after the administr ation of nitroglycerin. CONCLUSION: Both remifentanil and nitroglycerin are effecti ve in inducing controlled hypotension. In younger patients administrati on of nitroglycerin is associated with an increase in heart rate.