Abstract
Purpose
To determine in children whether remifentanil combined with sevoflurane, could induce controlled hypotension, reduce middle ear blood flow (MEBF) measured by laser-Doppler, and provide a satisfactory operative field.
Methods
Forty children undergoing middle ear surgery and anesthetized with sevoflurane were randomly assigned to receive either 1 μg·kg−1 remifentanil iv followed by a continuous infusion of 0.2 to 0.5 μg·kg−1min−1 or 0.25 μg · kg−1min−1 nitroprusside iv and alfentaniliv (n = 20 in each group).
Results
Controlled hypotension was achieved at the target mean arterial pressure (MAP) of 50 mmHg (P < 0.01) within 121 ±21 and 62 ± 9 sec for remifentanil and nitroprusside respectively. MEBF decreased by 22 ± 4 and 20 ± 6% and preceded the decrease in MAP within 20 ± 7 and 10 ± 3 sec for remifentanil and nitroprusside respectively. Remifentanil, and nitroprusside decreased MEBF autoregulation (0.41 ± 0.2 and 0.37 ± 0.3 respectively). Controlled hypotension was sustained in both groups throughout surgery, and the surgical field rating was good. Nitroprusside increased PaCO2 slightly, and there were no postoperative circulatory, neurological or metabolic complications in any of the groups.
Conclusion
Remifentanil combined with sevoflurane in children enabled controlled hypotension, reduced MEBF and provided good surgical conditions for middle ear surgery with no need for additional use of a specific hypotensive agent.
Résumé
Objectif
Déterminer si le rémifentanil, combiné au sévoflurane, peut permettre une hypotension contrôlée, une réduction du débit sanguin de l’oreille moyenne (DSOM) mesuré par Doppler à laser, et assurer un champ opératoire exsangue chez l’enfant.
Méthode
Quarante enfants opérés à l’oreille moyenne et anesthésiés par du sévoflurane, ont été répartis par randomisation en deux groupes (n = 20) recevant soit l μg kg−1 de rémifentanil iv suivi d’une perfusion continue de 0,2 à 0,5 μg kg−1 min−1, soit 0,25 μg kg−1 min−1 de nitroprussiate iv, associé à de l’alfentanil iv.
Résultats
Tout d’abord, l’hypotension contrôlée a été obtenue au niveau souhaité de 50 mmHg (P < 0,001) en 121 ± 21 et 62 ± 9 sec pour le rémifentanil et le nitroprussiate respectivement. Le DSOM a diminué de 22 ± 4 et de 20 ± 6 % et a précédé la chute de pression de 20 ± 7 et de 10 ± 3 sec pour le rémifentanil et le nitroprussiate respectivement. Le rémifentanil et le nitroprussiate ont diminué l’autorégulation (0,41 ± 0,2 et 0,37 ± 0,3). Ensuite, l’hypotension contrôlée a été maintenue dans les deux groupes tout au long de l’opération, et l’état du champ opératoire a été excellent. Le nitroprussiate a augmenté modérément la PaCO2. Il n’y a eu aucune complication circulatoire, neurologique ou métabolique postopératoire dans chacun des groupes.
Conclusion
Le rémifentanil associé au sévoflurane chez l’enfant a permis de réaliser une hypotension contrôlée, de réduire le débit sanguin de l’oreille moyenne et d’assurer de bonnes conditions opératoires pour l’opération de l’oreille moyenne sans recourir à un hypotenseur spécifique.
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Degoute, C.S., Ray, M.J., Gueugniaud, P.Y. et al. Remifentanil induces consistent and sustained controlled hypotension in children during middle ear surgery. Can J Anaesth 50, 270–276 (2003). https://doi.org/10.1007/BF03017797
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DOI: https://doi.org/10.1007/BF03017797