Hemodynamic effects, recovery profiles, and costs of remifentanil-based anesthesia with propofol or desflurane for septorhinoplasty

OBJECTIVE: To compare hemodynamics, recovery profiles, postoperative side effects and costs of desflurane-remifentanil and propofol-remifentanil anesthesia for septorhinoplasty operations.

METHODS: A prospective and randomized study was carried out at the Gazi University Hospital, Ankara, Turkey from April to September 2003. Forty patients undergoing septorhinoplasty operations were randomly allocated to receive desflurane-remifentanil (Group DES-REM) or total intravenous anesthesia (TIVA) (Group TIVA). Anesthesia was induced in both groups with remifentanil 1 microg x ml (-1), propofol 2-2.5 mg.kg-1 and pancuronium 0.1 mg.kg-1. Maintenance was achieved with O2 50% in air at 4 L.min-1 and infusion of remifentanil 0.1 microg x ml (-1).min-1 in both groups. Group DES-REM received desflurane at 1 minimum alveolar concentration and Group TIVA received 10-4 mg.kg-1.hour-1 of propofol. Propofol infusion and desflurane were discontinued with the last surgical stitches, but remifentanil infusion continued in both groups until the nose was covered with plaster. Hemodynamic variables were recorded during the operation and one hour postoperatively in 5 min intervals. We recorded time of extubation, spontaneous eye opening and response to verbal commands times, visual analog scale pain scores, postoperative nausea and vomiting and Aldrete Recovery Score. Drug dosages and costs of each technique were determined.

RESULTS: There were no statistically significant differences between the groups with respect to hemodynamic parameters, recovery profile, adverse effects, Aldrete Recovery Score and cost analysis. Visual analog scale at 5 min postoperatively was higher in group desflurane-remifentanil compared to group propofol-remifentanil (p<0.05).

CONCLUSION: Both desflurane-remifentanil and TIVA provide perioperative hemodynamic stability, early and easy recovery with similar cost profiles for septorhinoplasty operations.