Hypotensive anaesthesia with remifentanil combined with desflurane or isoflurane in tympanoplasty or endoscopic sinus surgery: a randomised, controlled trial

J Laryngol Otol. 2008 Jul;122(7):691-5. doi: 10.1017/S0022215107001545. Epub 2008 Feb 21.


Objective: To compare the effect of remifentanil combined with desflurane or isoflurane on the quality of the operative field and surgical conditions, blood loss, and recovery during tympanoplasty or endoscopic sinus surgery.

Design: Randomised, double-blinded clinical study.

Subjects: Sixty-four patients were scheduled for elective tympanoplasty or endoscopic sinus surgery. The patients were randomly divided into two groups: desflurane or isoflurane. After anaesthesia induction, all patients received a continuous remifentanil infusion of 0.2-0.5 microg/kg/min until a mean arterial pressure of 65-75 mmHg was achieved. Heart rate and mean arterial pressure were recorded throughout anaesthesia. Blood loss was measured at the end of surgery. Achievement of a bloodless operative field was rated on a 100 mm visual analogue scale. Following completion of surgery, the time to extubation and to achievement of an Aldrete score of nine or more was recorded.

Results: Sixty-three patients were evaluated. The total dose of remifentanil and the total blood loss were similar in both groups (p > 0.05). Time to extubation and to an Aldrete score of nine or more for the desflurane group was significantly less than for the isoflurane group (p 0.05).

Conclusion: Although desflurane and isoflurane both enabled good surgical conditions (in terms of quality of operative field) and convenient induction of hypotension for tympanoplasty and endoscopic sinus surgery, the recovery characteristics of desflurane were better than those of isoflurane. Therefore, desflurane may be preferable to isoflurane in such circumstances.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Anesthesia Recovery Period
  • Anesthetics, Combined / pharmacology*
  • Blood Loss, Surgical / prevention & control
  • Desflurane
  • Double-Blind Method
  • Endoscopy / methods
  • Female
  • Heart Rate / drug effects*
  • Humans
  • Hypotension / chemically induced
  • Isoflurane / analogs & derivatives*
  • Isoflurane / pharmacology
  • Male
  • Middle Aged
  • Nasal Polyps / surgery*
  • Piperidines / pharmacology*
  • Remifentanil
  • Sinusitis / surgery*
  • Treatment Outcome
  • Tympanoplasty / methods


  • Anesthetics, Combined
  • Piperidines
  • Desflurane
  • Isoflurane
  • Remifentanil