A comparison of propofol and sevoflurane for controlled hypotension proved by esmolol in nose surgery

We aimed the effect of controlled hypotension provided by esmolol on bleeding and operation quality, and efficiency of propofol and sevoflurane in controlled hypotension for nose surgery.After the study approved by faculty ethic committee, 60 patients whose ages were ranged between 18 and 60 years in group of ASA I-II were included to the study by their approval. Following the premedication with 0.05 mg/kg midazolam and 0.01 mg/kg atropin, induction was performed IV 2-3 mg/kg propofol, 1µg/kg fentanyl and 0.1 mg/kg vecuronium bromide. We randomly seperated the patients in to four groups: in Group P anesthesia was continued by 8 mg/kg/h propofol IV, 2 L/min O2 ve 2 L/min medical air inhalation; in Group S anesthesia was continued by 2 % sevoflurane, 2 L/min O2 and 2 L/min medical air inhalation; in Group PE and SE, to obtain 60 mmHg mean arterial pressure, in addition to previous medications 50-200 µg/kg/min of esmolol infusion was performed following 500 µg/kg of IV esmolol in bolus. Invasive systolic, diastolic and mean arterial pressure were fallowed during operation. The amount of bleeding, and pad, spanch and compress that used were recorded. The quality of operation field was assesed by surgeon with six point scala.When the groups were compared by the point scala for assesment of operation field; the point of Group P was higher than Group PE and SE (p<0.05) and the point of Group S was higher than Group SE (p<0.05). The amount of pads that used in Group P and Group S more than Group PE and SE (p<0.05). The amount of blood aspirated from the operation field was maximum in Group S and minimum in Group SE (p<0.05). The amount of esmolol used in group PE more than group SE (p<0.05).In conclusion, the method of controlled hypotension obtained by use of esmolol in TIVA with propofol and inhalation anesthesia with sevoflurane provided a clear operation field and decreased the bleeding. Also sevoflurane was better than propofol for clear operation field due to reduce bleeding and provide optimal arterial pressure in this method.Key words: controlled hypotension, esmolol, propofol, sevoflurane.