Comparison of the effects of nicardipine and remifentanil on surgical visual field and hemodynamic parameters in tympanomastoidectomy cases

Comparison of the Effects of Nicardipine and Remifentanil on Surgical Visual Field and Hemodynamic Parameters in Tympanomastoidectomy Cases Backround: We aimed to compare the effects of Nicardipine and Remifentanil on surgical visual field and hemodynamic parameters in microscopic tympanomastoidectomy cases with controlled hypotension (CH). Material – Method: The study was conducted with 64 patients. The age distribution of the patients was between 18-65. They were randomized into 2 groups, Group N (Nicardipine=32) and Group R (Remifentanil=32). After the input data is recorded before induction (T0); Propofol 2-2.5 mg/kg, fentanyl 1 mcg/kg and 0.5-0.6 mg/kg rocuronium intravenous (iv) were administered in the induction of anesthesia. 5 minutes after incision (T1), 20 minutes after incision (T2), during mastetoidectomy round (T3), during cholesteatoma clearance (T4), during grafting (T5), during extubation (T6), 10 minutes after extubation (T7), Systolic arterial pressure (SAB), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR) at the time of admission to the post-anesthesia care unit (PACU) (T8) and at the 15th minute (T9) in PACU ), peripheral oxygen saturation (SpO2) and end-tidal carbon dioxide pressure (EtCO2) values were measured. In the evaluation of the visibility of the surgical field, the Boezaart scale was used in B1: Skin incision, B2: Mastoidectomy during the tour, B3: Cholestatum clearance, B4: Grafting stage. In addition, nausea-vomiting and pain scoring in PACU were evaluated. Results: There was no significant difference in demographic data between the groups. Considering the hemodynamic parameters between the groups, HR values were higher in Group N throughout the entire period (T1-T9) (p<0.05). At T1, T6, T7, and T8 stages, DAB and MAP were lower in Group N (p<0.05). There was no significant difference between the groups in terms of SpO2 and EtCO2 (p>0.05). There was no significant difference in Boezart scoring, nausea-vomiting and pain scoring in both groups. Conclusion: Remifentanil and nicardipine provided similar surgical field vision quality in CH (controlled hypotension) application during tympanomastoidectomy. We think that nicardipine may be preferred in cases with sensitivity to the pathological effects of bradycardia, since it does not have a bradycardia-producing effect. Keywords: controlled hypotension, nicardipine, remifentanil, boezaart score, microscopic tympanomastoidectomy.