The effect of using esmolol with propofol-remifentanil induced hypotensive anesthesia on cardiac output, hemodynamic parameters and anesthesic drug needs

The aim of this study is to evaluate the effect of using esmolol with propofol remifentanil induced hypotensive anesthesia on cardiac output, hemodynamic parameters and anesthesic drug needs. After taking the permission of ethical committee, septorhinoplasty operation planned 40 adults were involved in the study. They had ASA I risk group and before they had been involved to the study, confirmation for the study was signed. 40 adult patients were divided into two randomised groups. The groups were like the following; remifentanil-propofol induced hypotensive anesthesia group (Group RP) and remifentanil- propofol esmolol induced hypotensive anesthesia group (Group RP-E). Mean arterial pressure was aimed to be at 55-65 mmHg and systolic arterial pressure was aimed to be below 80 rnmHg. Propofol 2-2.5 mg kg"1 iv was given for anesthesia induction to both groups. 0.6 mg kg"1 rocuronium was applied for myorelaxation. At group RP 1 p.g kg"1 bolus remifentanil was applied for 30 seconds intravenously. After application of 500 ug kg"1 iv esmolol at 30 seconds to Group RP-E, 100-300 ug kg _1 min"1 esmolol infusion was applied. 0.1-0.5 fig kg " 1 min"1 remifentanil infusion was begun after induction for both groups and 4 L dk"1 50/50 % (Vair was given. Operation had begun after 2 % lidocain hydrochlorur with adrenalin infiltration anesthesia. For anesthesia maintenance at Grup RP propofol (10-4 mg kg"1 hour"1) and remifentanil (0.1-0.5 p,g kg"1min"1) infusions were prepared for mean arterial pressure 55- 65 mmHg. For group RP-E, propofol (10-4 mg kg"1 hour"1) and remifentanil (0.1-0.5 p,g kg "'min'1) infusions were arranged to keep SNAP index score at 50±10. 100-300 ug kg-'min"1 esmolol infusion was applied to keep mean arterial pressure at 55-65 mmHg. Peroperative83 hemodynamic parameters, SNAP index, recovery times, VAS scores and side effects were observed. As at Group RP-E there is an decrease in intraoperative heart rate than Group RP, there was no difference between two groups at MAP and CO. There was no difference between recovery times between two groups. Total amount of remifentanil usage was much less at group RP-E than group RP-E. At group RP shivering was seen more than group RP-E significantly. PONV percent was low at both groups. After extubation VAS> 4 time was longer at group RP-E. There was no difference between two groups for patient satisfaction. Satisfaction of surgeons was more at group RP-E. As conclusion at TIVA by applying esmolol, opioid usage was lowered, stable hemodynamics without decrease in cardiac output and controlled hypotensive anesthesia was gained. This application makes a decrease in remifentanil amount, but on the other hand because of its high cost there is not a significant advantage for controlled hypotensive anesthesia