Use of remifentanil in comparison with sodium nitroprusside for controlled hypotension during rhinoplasty: Randomized controlled trail

Objective
To evaluate the clinical efficacy of remifentanil infusion in comparison with sodium nitroprusside regarding controlled hypotension during rhinoplasty.
Background
Controlled hypotension is a well-known technique used in many operations to reduce blood loss and need for blood transfusion and to provide satisfactory bloodless surgical field. Many pharmacological agents are used to perform controlled hypotension intraoperatively.
Patients and methods
A total of 130 adult consented patients of both sexes undergoing rhinoplasty aged 20–45 years with ASA I or II, were randomized to receive remifentanil infusion 0.25–0.5 μg/kg/min (group I = 65 patients) or sodium nitroprusside 0.5 μ/kg/min intraoperatively with adjusting dose till reaching target MAP around 80 mmHg. Anesthetic technique was standard for both groups. Time to onset of induced hypotension and time to target MAP were recorded in addition to heart rate during induced hypotension, PaO, PCO and PH together with the total infusion dose of the hypotensive agents in both groups.
Results
Remifentanil infusion intraoperatively induces adequate hypotension with no statistical significant difference to that induced by sodium nitroprusside ( < 0.05).
Conclusion
This study confirmed that remifentanil infusion with dose of 0.25–0.5 μg/kg/min. induced desired controlled hypotension intraoperatively during rhinoplasty with no complications occurred either intra- or postoperative with advantage of rapid recovery from anesthesia.