Key result
High-concentration remifentanil (8 ng/mL) significantly improved surgical field conditions at 90 minutes compared to low-concentration remifentanil (4 ng/mL) during endoscopic sinus surgery (mean score 2.25 vs 2.80, p=0.021).
Why the study?
Although combining propofol and remifentanil improves surgical field conditions during endoscopic sinus surgery compared with inhalation anaesthesia, the comparative effect of low versus high concentrations of remifentanil remained to be assessed.
Does high-concentration remifentanil improve surgical field conditions compared to low-concentration remifentanil in patients undergoing endoscopic sinus surgery?
RCT (n=54)
Single-blind
Computer-generated numbers
No
Does high-concentration remifentanil improve surgical field conditions compared to low-concentration remifentanil in patients undergoing endoscopic sinus surgery?
High-concentration remifentanil improves surgical field conditions during endoscopic sinus surgery by reducing heart rate and cardiac output.
Answers are grounded in this paper and cite their sources.
Higher remifentanil may improve late surgical conditions in ESS; extends dose data but leaves practice change open pending larger trials.
Background The combination of propofol and remifentanil results in better surgical field conditions during endoscopic sinus surgery than inhalation anaesthesia. This study compared surgical field conditions between groups receiving low or high concentration of remifentanil. Methods Fifty-four patients, ASA I or II were used to assign the patients to either the high-concentration remifentanil group (HR), targeted at 8 ng/mL or the low-concentration remifentanil group (LR), target was 4 ng/mL Surgical condition was evaluated using the Boezaart Surgical Field Grading Scale presented by Boezaart. Discussion When comparing the HR group and the LR group, the surgeon observed a significant difference in surgical conditions. The reason was the significant decrease in cardiac output. This reduction was because of the effect of remifentanil on reducing heart rate rather than stroke volume.
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Jeong et al. (2023) conducted an RCT in Endoscopic sinus surgery (n=54). Remifentanil vs. Remifentanil 4 ng/mL was evaluated on Surgical field condition assessed by the Boezaart Surgical Field Grading Scale at 90 minutes (p=0.021). High-concentration remifentanil (8 ng/mL) significantly improved surgical field conditions at 90 minutes compared to low-concentration remifentanil (4 ng/mL) during endoscopic sinus surgery (mean score 2.25 vs 2.80, p=0.021).
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