Comparison of Metoprolol and Tramadol with Remifentanil in Endoscopic Sinus Surgery: A Randomised Controlled Trial

Özet

Objective: Controlled hypotension is commonly induced during functional endoscopic sinus surgery to limit mucosal bleeding. Thismay be detrimental to elderly patients and patients with arterial stenosis. The aim of this pilot study was to determine if a normotensiveanaesthetic technique with sufficient analgesia and without profound vasodilation may reduce intraoperative bleeding and incidence ofadverse haemodynamic effects associated with vasodilation and variable rate continuous infusions.Methods: In this double-blind randomised controlled trial in a tertiary care centre, a total of 88 patients were randomised to receive intravenouslyeither 0.1 mg kg−1 metoprolol and 1 mg kg−1 tramadol following anaesthesia induction (MT group) or a bolus dose of 0.5 μg kg−1remifentanil following anaesthesia induction, followed by 0.25-0.5 μg kg−1 min−1 remifentanil infusion (R group). The primary outcomewas quality of surgical field and incidence of adverse haemodynamic effects. The secondary outcomes were time to achieve intraoperativebleeding score <3, bleeding rate and changes in cerebral regional oximetry.Results: A total of 105 patients were recruited, in which 88 were randomised. The median intraoperative bleeding score was similar (1, interquartilerange: 1-1, p=0.69). The mean bleeding rate was lower in the MT group, although the difference was not significant (p=0.052,95% CI 0 to 8.8). Hypotension, bradycardia and cerebral desaturation in the MT group were not observed compared to hypotension in3 (7%), bradycardia in 18 (41%) and cerebral desaturation in 2 (5%) patients in the R group (p=0.241, p<0.001, p=0.474, respectively).Conclusion: Providing sufficient analgesia and eliminating stress response can provide stable heart rate and good surgical field with noneed for additional hypotension. This normotensive technique may be useful in patients with stenotic arteries or ischaemic organ diseases.