Comparison of the effect of two doses of remifentanil infusion on the amount of bleeding, intraoperative hemodynamic changes and complications after rhinoplasty surgery with general anesthesia

Background: This study was conducted to compare the effect of two doses of remifentanil infusion on the amount of bleeding, intraoperative hemodynamic changes, and complications after rhinoplasty surgery with general anesthesia. Methods: This prospective randomized clinical trial study was conducted on 80 patients who were candidates for rhinoplasty from March 1401 to August 1402 in Al-Zahra Hospital, Isfahan, Iran. The participants were divided into two groups of 40 people using random allocation software. remifentanil infusion was adjusted in the first group with a dose of 0.15-0.25 mg/kg/min and in the second group with a dose of 0.25-0.35 mg/kg/min. The goal was to maintain mean arterial pressure (MAP) between 60 and 65 mmHg, to achieve this goal, reducing or increasing the rate of remifentanil infusion was used. During the operation, a heart rate of less than 50 beats per minute was considered bradycardia and was treated with atropine 0.015 mg/kg. In addition, the remifentanil infusion rate was reduced if MAP fell below 60 mmHg for more than 60 seconds. Patients were evaluated and compared during operation and recovery in terms of hemodynamic parameters, intraoperative bleeding and postoperative complications. Results: There was no significant difference between the two groups in the changes of hemodynamic parameters during surgery and recovery (P>0.05). The average bleeding volume in the two groups receiving remifentanil 0.15-0.25 mcg/kg/min and 0.25-0.35 mcg/kg/min Remifentanil was 44.25±23.1 and 28.25±15.5 ml, respectively, and the difference between the two groups was significant (P<0.001). According to the surgeon's opinion, intraoperative bleeding in the 0.25-0.35 mcg/kg/min remifentanil group was significantly lower than 0.15-0.25 (P=0.001). Conclusion: According to the findings of the present study, it seems that the use of 0.25-0.35 min/µg/kg dose of remifentanil compared to 0.15-0.25 min/µg/kg dose, is associated with a significant reduction in bleeding during rhinoplasty, and also the use of this dose is not associated with the occurrence of serious hemodynamic disorders, including bradycardia and severe drop in blood pressure.