Comparison of the Effect of Remifentanil and Nitroglycerin on Intraoperative Blood Pressure and Intraoperative and Postoperative Complications during Rhinoplasty: Care and Prevention

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Surgery, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran

2 Student of Medicine, Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran

3 Assistant Professor, Department of Intensive Care, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran

4 Associate Professor, Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran

Abstract

Background: Hemodynamic changes are one of the most important risk factors for complications in rhinoplasty. The aim of this study was to compare the effect of remifentanil and nitroglycerin on intraoperative blood pressure and other complications during and after rhinoplasty in surgical center.Methods: This was a quasi-experimental double-blind study performed on patients referred to Imam Ali Clinic of Shahrekord University of Medical Sciences, Iran, for rhinoplasty in year 2017. 50 rhinoplasty candidates with class one and two American Society of Anesthesiologists (ASA) were randomly divided into two groups of 25. Simultaneously, with the administration of anesthesia in the first group, remifentanil (0.1-0.3 μg/kg/minute) and in the second group, nitroglycerin (0.5-1 μg/kg/minute) were administered. During the surgery, heart rate, bleeding, systolic and diastolic blood pressure, were recorded. Moreover, the amount and degree of ecchymosis and edema were determined.Results: There was no significant difference between the two groups in terms of duration of surgery, bleeding during surgery, mean heart rate, ecchymosis, edema, and diastolic blood pressure at different times. Mean heart rate and diastolic blood pressure at different time were not significantly different between the two groups, too. But, the amount of reducing in systolic blood pressure at 5 minutes in remifentanil group (17.64 ± 14.39 mmHg) was significantly lower than nitroglycerin group (25.60 ± 7.09 mmHg).Conclusion: The results indicate similar function of remifentanil and nitroglycerin in reducing intraoperative bleeding and complications during and after rhinoplasty surgery.

Keywords

References

  1. Heidekrueger PI, Juran S, Patel A, Tanna N, Broer PN. Plastic surgery statistics in the us: Evidence and implications. Aesthetic Plast Surg 2016; 40(2): 293-300.
  2. Niknam M, Fararoui M, Kamkar AL, Fouladi N, Mohamadi A. Comparison of perfectionism in people who have cosmetic rhinoplasty surgery and control group in yasouj city. Payavard Salamat 2012; 6(1): 52-60. [In Persian].
  3. Mohammadpanah Ardakan A, Yousefi R. Assessment of beliefs about appearance and inferiority feeling in cosmetic surgery candidates. Dermatol Cosmet 2011; 2(2): 85-97. [In Persian].
  4. Morowatisharifabad MA, Rezaeipandari H, Allahyari B, Zarei T, Heydari GA. The study of self-reported problems and complications of rhinoplasty in Yazd City. Journal of Jiroft University of Medical Sciences 2015; 1(1): 68-76. [In Persian].
  5. Mortazavi MT, Toutounchi JS, Ansari M, Gojazadeh M, Toutounchi NS. Results and consequences during and after Rhinoplasty. Med J Tabriz Univ Med Sci 2013; 35(3): 88-91. [In Persian].
  6. Rettinger G. Risks and complications in rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6: Doc08.
  7. Khamestan M, Sadeghi SE, Samadi K, Forouzan M. Evaluating the effect of remifentanil infusion vs. single dose intravenous hydralazine plus propranolol to provide controlled hypotension in patients undergoing rhinoplasty in Khalili Hospital of Shiraz. J Anesth Pain 2016; 7(1): 21-9. [In Persian].
  8. Kosucu M, Omur S, Besir A, Uraloglu M, Topbas M, Livaoglu M. Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty. J Craniofac Surg 2014; 25(2): 471-5.
  9. Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag 2008; 4(3): 615-27.
  10. Aronow WS. Management of hypertension in patients undergoing surgery. Ann Transl Med 2017; 5(10): 227.
  11. Delarrat M, Chelly J, Garcia A, Kergrohen F, Passelecq J. Clinical use of nitroglycerin as an hypotensive agent during general anesthesia for caesarean section. Report of a case (author's transl). Anesth Analg (Paris) 1980; 37(11-12): 719-21. [In French].
  12. Kaczmarowski, Narelle. Patient care in the operating room. London, UK: Churchill Livingstone; 1987.
  13. Ghodrati M, Zadimani A. Comparison of blood loss in septorhinoplasty with two different anesthetic technique; propofol or isoflurane. J Anesth Pain 2011; 2(5): 1-8. [In Persian].
  14. Meyer R. Secondary and functional rhinoplasty: The difficult Nose. London, UK: Grune and Stratton; 1988.
  15. Aghadoost D, Fazel MR, Fakharian E. Comparing remifentanil versus propofol effect on pain and homodynamic change of patients undergoing phacoemulsification with topical anesthesia. Iran Red Crescent Med J 2013; 15(5): 424-7.
  16. Nasiri E, Soliamani A, Mohammadpour RA, Donyavi R, Jafari H. Comparison between the effectcs of remifentanil and fentanyl on blood pressure and cardiac dysrythmia during tracheal intubation in CABG. J Mazandaran Univ Med Sci 2010; 20(76): 24-31. [In Persian].
  17. Bajwa SJ, Kaur J, Kulshrestha A, Haldar R, Sethi R, Singh A. Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation. J Anaesthesiol Clin Pharmacol 2016; 32(2): 192-7.
  18. Mishra A, Singh R, Choubey S, Tripathi R, Sarkar A. A comparison between nitroprusside and nitroglycerine for hypotensive anesthesia in ear, nose, and throat surgeries: A double-blind randomized study. Med J DY Patil Univ 2015; 8(2): 182-8.
  19. Guney A, Kaya FN, Yavascaoglu B, Gurbet A, Selmi NH, Kaya S, et al. Comparison of esmolol to nitroglycerine in controlling hypotension during nasal surgery. Eurasian J Med 2012; 44(2): 99-105.
  20. Srivastava U, Dupargude AB, Kumar D, Joshi K, Gupta A. Controlled hypotension for functional endoscopic sinus surgery: comparison of esmolol and nitroglycerine. Indian J Otolaryngol Head Neck Surg 2013; 65(Suppl 2): 440-4.
  21. Alkan A, Honca M, Alkan A, Gulec H, Horasanli E. The efficacy of esmolol, remifentanil and nitroglycerin in controlled hypotension for functional endoscopic sinus surgery. Braz J Otorhinolaryngol 2021; 87(3): 255-9.
  22. Kim HJ, Jun JH, Yoo HK, Kim KS, Choi WJ, Cho YH. The effects of remifentanil, lidocaine, nicardipine and nitroglycerin on hemodynamic changes during tracheal intubation. Korean J Anesthesiol 2008: 54(6); 614-8.
  23. Cantarella G, La Camera G, Di Marco P, Grasso DC, Lanzafame B. Controlled hypotension during middle ear surgery: Hemodynamic effects of remifentanil vs nitroglycerin. Ann Ital Chir 2018; 89: 283-6.

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History

  • Receive Date: 21 February 2021
  • Revise Date: 23 May 2024
  • Accept Date: 06 April 2022

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