Induced hypotension for tympanoplasty: a comparison of desflurane, isoflurane and sevoflurane

Background and objectives: This prospective, randomized, double-blinded study was designed to compare the effects of desflurane, isoflurane and sevoflurane when combined with remifentanil for induced hypotension on surgical conditions and operative field during tympanoplasty. Methods: Sixty patients undergoing tympanoplasty were enrolled in the study. The patients were randomized into three groups of 20 each to receive the inhalation anaesthetics desflurane, isoflurane or sevoflurane. Propofol 2 mg kg−1 was administered for induction of anaesthesia in all groups. All patients received a continuous infusion of remifentanil which was titrated between 0.2 and 0.5 μg kg−1 min−1 to achieve a mean blood pressure (BP) of 60-70 mmHg. Nitroglycerine was infused if this BP could not be achieved. Arterial pressures were recorded continuously throughout the operation. Surgical conditions were assessed every 20 min by the blinded surgeon using a six-point category scale (0-5). Results: One patient in the desflurane group and two patients in isoflurane group required nitroglycerine to maintain desired mean BP. Sustained controlled hypotension was sufficient in all of the groups throughout surgery. Category scale scores were ⩽3 throughout the study, except one patient in the sevoflurane group who had a score of 4 at the 60th minute of the operation. No difference was found among groups when haemodynamic parameters and surgical category scale scores were compared. There were no postoperative respiratory and circulatory complications. Conclusion: Desflurane, sevoflurane or isoflurane combined with remifentanil provided adequate induced hypotension and similar operating conditions and any of them could be safely and equally used in anaesthesia for tympanoplasty.