Haemodynamic effects of propofol and desflurane during remifentanil-based anaesthesia with controlled hypotension for paediatric otorhinolaryngeal surgery

Introduction. The aim of the study was to compare haemodynamic effects of propofol with desflurane during remifentanil-based anaesthesia for paediatric otorhinolaryngeal surgery. Material and methods. Forty-one ASA I-II children, aged 7 – 18 years, were randomly assigned to two groups to receive remifentanil and propofol (PRO) or remifentanil and desflurane (DES). After standardised premedication and induction, anaesthesia was maintained with 3-4 mg/kg/h propofol (PRO) or 3-4% desflurane in the oxygen/air mixture. Analgesia was provided in both groups with continuous infusion of 0.75 μg/kg/min remifentanil. MAP was maintained within the range of 50 to 65 mmHg to reduce bleeding in the surgical field. Bradycardia and hypotension were treated with rescue atropine or/and fluid replacement or/and decrease of the remifentanil infusion rate. Surgical conditions were assessed by an attending surgeon who used a bleeding score classification. Results. The targeted MAP was achieved in most cases in both groups (ns). MAP < 50 mmHg occurred more frequently in DES group (p<0.05), MAP > 65 mmHg was more frequently observed in PRO group (p<0.05). Mean intraoperative HR and MAP were higher in PRO group (p<0.05). HR after the extubation was higher in DES group (p<0.05). The incidence of severe hypotensive and bradycardic episodes were higher in DES group (ns), as well as the need for atropine administration (ns) and remifentanil infusion rate decrease (ns). Intravenous fluid resuscitation was more frequently required in DES group (p<0.05). In both groups intraoperative bleeding was assessed as minimal and the surgical field was rated satisfactory. Conclusions. Both methods were equally effective in inducing and maintaining controlled hypotension and both provided satisfactory surgical conditions. The circulation was less stable when desflurane and remifentanil were used. Therefore, the protocol based on propofol-remifentanil seems to be preferable for paediatric ENT surgery which requires minimal bleeding. Anestezjologia i Ratownictwo 2010; 4: 301-306