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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

language: Italian

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.

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