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Remifentanil induces consistent and sustained controlled hypotension in children during middle ear surgery

[Le rémifentanil induit de l’hypotension constante et prolongée chez des enfants pendant une opération de l’oreille moyenne]

Christian S. Degoute, MD PhD^*, Marie J. Ray, MD^*, Pierre Y. Gueugniaud, MD PhD^* and Christian Dubreuil, MD

^* From the Department of Anesthesiology, and
ENT Surgery, Centre Hospitalo-Universitaire Lyon-Sud, France.

Address correspondence to: Dr. Christian S. Degoute, Secrétariat de consultation d’anesthésie CHU de Pointe-à-Pitre/Abymes, 97159 Pointe-à-Pitre cedex, France. Phone: 33 0590 89 13 44; Fax: 33 0590 89 17 90; E-mail: christian.degoute{at}wanadoo.fr

Purpose: To determine in children whether remifentanil combined with sevoflurane, could induce controlled hypotension, reduce middle ear blood flow (MEBF) measured by laser-Doppler, and provide a satisfactory operative field.

Methods: Forty children undergoing middle ear surgery and anesthetized with sevoflurane were randomly assigned to receive either 1 µg•kg^-1 remifentanil iv followed by a continuous infusion of 0.2 to 0.5 µg•kg^-1•min^-1 or 0.25 µg•kg^-1•min^-1 nitroprusside iv and alfentanil iv (n = 20 in each group).

Results: Controlled hypotension was achieved at the target mean arterial pressure (MAP) of 50 mmHg (P < 0.01) within 121 ± 21 and 62 ± 9 sec for remifentanil and nitroprusside respectively. MEBF decreased by 22 ± 4 and 20 ± 6% and preceded the decrease in MAP within 20 ± 7 and 10 ± 3 sec for remifentanil and nitroprusside respectively. Remifentanil, and nitroprusside decreased MEBF autoregulation (0.41 ± 0.2 and 0.37 ± 0.3 respectively). Controlled hypotension was sustained in both groups throughout surgery, and the surgical field rating was good. Nitroprusside increased PaCO₂ slightly, and there were no postoperative circulatory, neurological or metabolic complications in any of the groups.

Conclusion: Remifentanil combined with sevoflurane in children enabled controlled hypotension, reduced MEBF and provided good surgical conditions for middle ear surgery with no need for additional use of a specific hypotensive agent.