Canadian Journal of Anaesthesia

, Volume 50, Issue 3, pp 270–276 | Cite as

Remifentanil induces consistent and sustained controlled hypotension in children during middle ear surgery

  • Christian S. Degoute
  • Marie J. Ray
  • Pierre Y. Gueugniaud
  • Christian Dubreuil
Obstetrical and Pediatric Anesthesia

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.

Le rémifentanil induit de l’hypotension constante et prolongée chez des enfants pendant une opération de l’oreille moyenne

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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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Christian S. Degoute
    • 1
  • Marie J. Ray
    • 1
  • Pierre Y. Gueugniaud
    • 1
  • Christian Dubreuil
    • 2
  1. 1.Department of AnesthesiologyCentre Hospitalo-Universitaire Lyon-SudFrance
  2. 2.ENT SurgeryCentre Hospitalo-Universitaire Lyon-SudFrance

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