Several methods have been suggested to
decrease bleeding during surgery, one of which is the usage of hypotensive
anesthetic agents. Endoscopic Sinus Surgery (ESS) is one of the surgeries which
need a clear field and the amount of bleeding profoundly impacts the ability of
surgeons. Current study was designed to evaluate the effect of remifentanil
combined with propofol versus Isoflurane on blood loss during ESS and its
possible interaction with Depth of Anesthesia. Fifty one patients comprising 15
females and 36 males undergoing ESS were chosen for this study. One group received
propofol and remifentanil to induce and maintain anesthesia and the second
group received Isoflurane. Mean Arterial Blood Pressure (MAP), Depth of
Anesthesia and total blood loss were recorded for the patients of both group.
Data were analyzed using t-test, Repeated Measures ANOVA and Pearson’s
correlation. P<0.05 was considered statistically
significant. Both agents induced hypotension during surgery. No significant
difference was observed in total blood loss between two groups. DA was
decreased in both groups, but no significant correlation was found between DA
and MAP or DA and blood loss. There is no significant difference between
remifentanil combined with propofol and Isoflurane in decreasing blood loss
during ESS, thus we suggest usage of hypotensive anesthetic agent regardless of
its type is ESS.
Cite this paper
M. Haghbin, H. Hakimzadeh and M. Shabani, "Evaluating the Efficacy of Remifentanil-Propofol versus Isoflurane in Reducing Blood Loss with Considering Depth of Anesthesia during Endoscopic Sinus Surgery," Neuroscience and Medicine, Vol. 4 No. 2, 2013, pp. 59-62. doi: 10.4236/nm.2013.42009.
 H. S. Yoo, J. H. Han, S. W. Park and K. S. Kim, “Comparison of Surgical Condition in Endoscopic Sinus Surgery Using Remifentanil Combined with Propofol, Sevoflurane, or Desflurane,” Korean Journal of Anesthesiology, Vol. 59, No. 6, 2010, pp. 377-382.
 C. S. Degoute, M. J. Ray, P. Y. Gueugniaud and C. Dubreuil, “Remifentanil Induces Consistent and Sustained Controlled Hypotension in Children during Middle Ear Surgery,” Canadian Journal of Anesthesia, Vol. 50, No. 3, 2003, pp. 270-276. doi:10.1007/BF03017797
 C. S. Degoute, M. J. Ray, M. Manchon, C. Dubreuil and V. Banssillon, “Remifentanil and Controlled Hypotension; Comparison with Nitroprusside or Esmolol during Tympanoplasty,” Canadian Journal of Anesthesia, Vol. 48, No. 1, 2001, pp. 20-27. doi:10.1007/BF03019809
 F. Richa, et al., “Comparison between Dexmedetomidine and Remifentanil for Controlled Hypotension during Tympanoplasty,” European Journal of Anaesthesiology, Vol. 25, No. 5, 2008, pp. 369-374.
 J. D. Pavlin, P. S. Colley, E. A. Weymuller, G. V. Norman, H. C. Gunn and M. E. Koerschgen, “Propofol versus Isoflurane for Endoscopic Sinus Surgery,” American Journal of Otolaryngology, Vol. 20, No. 2, 1999, pp. 96-101. doi:10.1016/S0196-0709(99)90018-2
 M. Nakayama, H. Ichinose, S. Yamamoto, N. Kanaya and A. Namiki, “The Bispectral Index Response to Tracheal Intubation Is Similar in Normotensive and Hypertensive patients,” Canadian Journal of Anesthesia, Vol. 49, No. 5, 2002, pp. 458-460. doi:10.1007/BF03017920
 A. G. Beule, F. Wilhelmi, T. S. Kuhnel, E. Hansen, K. J. Lackner and W. Hosemann, “Propofol versus Sevoflurane: Bleeding in Endoscopic Sinus Surgery,” Otolaryngol Head Neck Surgery, Vol. 136, No. 1, 2007, pp. 45-50.
 J. H. Ryu, I. S. Sohn and S. H. Do, “Controlled Hypotension for Middle Ear Surgery: A Comparison between Remifentanil and Magnesium Sulphate,” British Journal of Anaesthesia, Vol. 103, No. 4, 2009, pp. 490-495.
 K. E. Blackwell, D. A. Ross, P. Kapur and T. C. Calcaterra, “Propofol for Maintenance of General Anesthesia: A Technique to Limit Blood Loss during Endoscopic Sinus Surgery,” American Journal of Otolaryngology, Vol. 14, No. 4, 1993, pp. 262-266.
 H. Ahn, S. K. Chung, H. J. Dhong, H. Y. Kim, J. H. Ahn, S. M. Lee, T. S. Hahm and J. K. Kim, “Comparison of Surgical Conditions during Propofol or Sevoflurane Anaesthesia for Endoscopic Sinus Surgery,” British journal of Anaesthesia, Vol. 100, No. 1, 2008, pp. 50-54.
 S. P. Ankichetty, M. Ponniah, V. Cherian, S. Thomas, K. Kumar, L. Jeslin, K. Jeyasheela and N. Malhotra, “Comparison of Total Intravenous Anesthesia Using Propofol and Inhalational Anesthesia Using Isoflurane for Controlled Hypotension in Functional Endoscopic Sinus Surgery,” Journal of Anaesthesiology Clinical Pharmacology, Vol. 27, No. 3, 2011, pp. 328-332.