Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty

BACKGROUND: This randomized, double-blind study was designed to assess the effect of perioperative remifentanil with controlled hypotension on intraoperative bleeding, postoperative edema, and ecchymosis. METHODS: Fifty-two patients undergoing rhinoplasty were divided into 2 groups. The remifentanil group received 1 μg · kg intravenously as a bolus before induction of anesthesia, 0.5 to 1 μg · kg · h by continuous intravenous infusion during the operation. After anesthesia induction with propofol (2-3 mg · kg) and fentanyl (1-15 μg · kg), muscle relaxation was achieved with rocuronium (0.45-0.90 mg · kg). Mean arterial pressure was maintained at 50 to 60 mm Hg in controlled hypotensive anesthesia achieved using remifentanil infusion. Perioperative hemodynamics and bleeding; early postoperative pain and agitation scale; postoperative first, third, and seventh day edema; and ecchymosis were evaluated. Edema and ecchymosis were evaluated using graded scale from 0 to 4. RESULTS: Remifentanil reduced mean arterial pressure during the entire operative period and the first 30 minutes postoperatively (P < 0.05 for these comparisons). Intraoperative bleeding also decreased (P < 0.001). There was a significant decrease in edema in both upper and lower eyelid edema on the first and third days in the remifentanil group, although this difference was not detected on the seventh day (P1upper = 0.000, P1lower = 0.000, P3upper = 0.008, and P3lower = 0.002). Ecchymosis decreased significantly in both upper and lower eyelids on the first, third, and seventh days in the remifentanil group (P1upper = 0.000, P3upper = 0.000, P3upper = 0.002, P3lower = 0.002, P7upper = 0.049, and P7lower = 0.038). There were no differences in postoperative pain and agitation between 2 groups. CONCLUSIONS: Remifentanil with controlled hypotension may reduce edema and ecchymosis of the upper and lower eyelids, by reducing mean arterial pressure and amount of bleeding in rhinoplasty. © 2014 Mutaz B. Habal, MD.