Hypotensive anesthesia during functional endoscopic sinus surgery: a comparative study of remifentanil versus magnesium sulfate infusion

Abstract

Objective The aim of this study was to compare the adequacy and outcome of controlled hypotensive anesthesia using remifentanil or magnesium sulfate during functional endoscopic sinus surgery (FESS). Patients and methods The study included 104 patients with chronic rhinosinusitis assigned for FESS. They were randomly divided into two equal groups: group R received remifentanil loading dose of 1 μg/kg over 60 s, followed by 0.15 μg/kg/min infusion, and group M received magnesium sulfate loading dose of 40 mg/kg over 10 min, followed by 15 mg/kg/h infusion. Hemodynamic variables were noninvasively monitored and expressed every 15 min. Operative field bleeding and subsequently its visibility were graded using a six-point scale. Recovery time was estimated as the time until the patient achieves a modified Aldrete scoring of 11 or more. The degree of sedation was assessed using the Brussels Sedation Scale. Results The mean collective heart rate and mean arterial pressure measures were signifi cantly low in group R compared with group M. The mean amount of collected blood loss and total field visibility scale score were significantly lower with remifentanil than with magnesium sulfate. The frequency of patients who achieved early recovery was significantly higher with remifentanil with significantly shorter time to achieve modified Aldrete scoring of 11 or more compared with magnesium sulfate. Conclusion Controlled hypotensive anesthesia minimized bleeding and provided excellent fi eld visibility during FESS. Remifentanil provided superior outcome manifested as signifi cant reduction in operative field bleeding, better field visibility, and shorter operative time compared with magnesium sulfate. In addition, remifentanil provided early recovery without postoperative sedation and thus allowed FESS to be conducted as a day-case surgery.