Effects of nicardipine and remifentanil combination on surgical visual field and hemodynamic parameters in functional endoscopic sinus surgery cases

Aim: In this study, we investigated the effects of the Nicardipine/Remifentanil combination used for controlled hypotension (CH) to reduce bleeding and improve the endoscopic field of view on the surgical field of view, hemodynamic data, postoperative nausea, vomiting, and pain in Functional Endoscopic Sinus Surgery Cases. Materials and Methods: Our patients aged between 18 and 65 years were included in our study. Patients were randomly divided into two groups. Group R (Remifentanil) included 36 patients and Group RN (Remifentanil/Nicardipine combination) included 37 patients. Following intubation in Group R: Remifentanil: 0.05-2.0 μg/kg/min, Group RN: Remifentanil: 0.025-1 μg/kg/min, Nicardipine: 0.5-3.5 μg/kg/min intravenous (iv) infusion was started. In Group R and Group RN, the average target mean arterial pressure (MAP) was determined as 50-65 mmHg, and drug doses were increased until the targeted MAP was reached. Systolic arterial pressure (SBP), diastolic arterial pressure (DBP), MAP, and heart rate (HR) values were recorded every fifteen minutes at T0; before induction, T8; during extubation, T9; at 10 minutes in the post-anesthesia care unit (PACU). End-tidal carbon dioxide (EtCO2) values were collected every fifteen minutes after induction until extubation. The amount of bleeding, need for aspiration, and surgical field visibility were evaluated every 15 minutes after the start of the surgical operation using the Boezaart scale. Duration of PACU stay, nausea and vomiting, and pain assessment with the Numerical Rating Scale (NRS) pain scale were performed. Results: PACU length of stay was significantly shorter in group RN than in group R (p=0.003). There was a statistically significant difference between the groups in NRS pain scoring and it was higher in group R (p=0.001). Nausea and vomiting scores showed a statistically significant difference between the groups and were lower in group RN (p=0.037). SAB and OAB were significantly lower in group RN (p=0.018 and p=0.023). There was a significant difference in the distribution of HR within both groups during all periods and it was higher in group RN (p= ˂0.001). There was a notable difference in the distribution of Boezaart score in both groups during all periods and it was found to be lower in group RN (p= ˂0.001). Conclusion: Remifentanil/Nicardipine combination for application of CH in functional endoscopic sinus surgery provides a better surgical field quality. This combination is preferable to remifentanil alone because it is more successful in maintaining CH on the one hand and postoperative pain scores and nausea as well as vomiting on the other hand. Keywords: Controlled hypotension, nicardipine/remifentanil combination, functional endoscopic sinus surgery.