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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2000 March;50(1):35-40
Remiphentanyl in middle ear surgery
Albera R., Pallavicino F. *, De Siena L. *, Gervasio C. F., Cavalot A. L., Canzoneri L. *, Giordano L., Ferrero V.
Università degli Studi - Torino Dipartimento di Fisiopatologia Clinica II Sezione di ORL
*Dipartimento Discipline Medico Chirurgiche Sezione di Anestesia
Background. The middle ear microsurgery takes place in an area in which hemostasis, for anatomical reasons, cannot be carried out so easily. The use of anesthesiologic techniques such as controlled low blood-pressure becomes necessary to face this need. The aim of this study is to compare remiphentanyl with phentanyl in obtaining and maintaining an efficacious controlled low blood pressure in subjects undergoing otologic surgery.
Methods. Ninety-two patients operated on for tympanoplasty have been studied. In 47 cases anesthesia was maintained by using remiphentanyl (0.5 µg/kg/min), N2O at 60%, O2 at 40% and sevoflurane at 1%, in 45 cases with phentanil at 1 γ/kg/ora and with a mixture of N2O at 60%, O2 at 40% and sevoflurane at 1%.
Results. The reduction of pressure values in patients treated with remiphentanyl was greater in comparison with patients treated with phentanyl and such values have been reached faster, without any side-effects except for a higher number of awakening vomiting well controlled with ondasetron. Moreover, with remiphentanyl a shorter duration of the awakening time compared with phentanyl was observed.
Conclusions. In otologic surgery, the maintaining of anesthesia and of a controlled low-blood pressure with remiphentanyl can be considered a safe and effective technique in terms of controllability, reversibility and without any side-effects. Moreover, the shorter awakening time means a reduction of time in the operating theatre with an easier management of patients and reduced expenses.