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Anesthetic Pharmacology
Anesthesia and Pain Medicine 2010;5(1):38-44.
Published online January 30, 2010.
Controlling deliberate hypotension in hypertensive patients undergoing spinal surgery: a comparison between remifentanil and sodium nitroprusside
Sang Hyun Park, Sang Hwan Do, Chong Soo Kim, Young Jin Ro, Sung Hee Han, Jin Hee Kim, Kyoun Ah Han
1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. shdo@snu.ac.kr
2Department of Anesthesiology and Pain Medicine, Seoul National University Boramae Medical Center, Seongnam, Korea.
3Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Korea.
Abstract
BACKGROUND
This study was designed to determine whether remifentanil or sodium nitroprusside (SNP) with sevoflurane anesthesia can induce safe deliberate hypotension (DH) to a target mean arterial pressure (MAP) of 55-65 mmHg in patients with controlled hypertension.
METHODS
Thirty patients with controlled hypertension and who were scheduled for posterior lumbar interbody fusion were randomly assigned to receive remifentanil (n = 15, group R) or SNP (n = 15, group S).All the patients received a balanced anesthetic technique including 1.5-2 vol% sevoflurane.Group R received remifentanil by target-controlled infusion.The infusion was initiated with a target concentration at 4 ng/ml and this was adjusted every 1 min by 1 ng/ml to maintain the MAP to the target level of 55-65 mmHg.In group S, the infusion of SNP was initiated at 1 ug/kg/min and this was increased by 0.5 ug/kg/min.Cerebral oximetry was done and the cardiac index was measured with esophageal Doppler.
RESULTS
DH was achieved at a MAP = 60 mmHg within 5.7 min for group R and 3.7 min for group S.The intraoperative blood loss was lower in Group R than that in Group S (304 +/- 103 vs 650 +/- 141 ml, P < 0.05).The frequency of added ephedrine injection to control the MAP and discontinuation of the study drug due to a MAP < 60 mmHg were higher in group S than in group R (46% vs 13%, P < 0.05 and 62% vs 20%, P < 0.05, respectively).
CONCLUSIONS
Compared to SNP, remifentanil with sevoflurane anesthesia induced safer DH for patients with controlled hypertension.
Key Words: Deliberate hypotension, Remifentanil, Sodium nitroprusside
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