Abstract

ABSTRACT
Objective: This study examined the impact of using a Nicardipine/Remifentanil combination for controlled hypotension (CH) in Functional Endoscopic Sinus Surgery (FESS) cases. The goal was to minimize bleeding and enhance the visibility of the endoscopic field. The study focused on surgical field visibility, hemodynamic data, and the impact on postoperative nausea, vomiting, and pain.
Materials and Methods: Our study included 73 patients between the ages of 18 and 65. The patients were randomly assigned to two groups. Group R (Remifentanil) consisted of 36 patients, and Group RN (Remifentanil/Nicardipine combination) consisted of 37 patients. Following intubation, In Group R, patients were administered an intravenous (IV) infusion of Remifentanil at a rate of 0.05–2.0 µg/kg/min, while Group RN received Remifentanil at 0.025–1 µg/kg/min , Nicardipine at 0.5–3.5 µg/kg/min. The target mean arterial pressure (MAP) for both groups was set at 50–65 mmHg. After the surgical procedure began, bleeding volume, suction requirements, and surgical field visibility were assessed at 15-minute intervals with the Boezaart scale. Duration of stay in the Post Anesthesia Care Unit (PACU), incidence of nausea vomiting; pain assessment with the Numeric Rating Scale (NRS) were evaluated..
Results: PACU length of stay was considerably shorter in Group RN compared to Group R (p=0.003). Pain scoring was greater in Group R (p=0.001). Nausea vomiting scores were less in group RN (p=0.037). SAP and MAP were considerably lower in group RN (p=0.018 and p=0.023). HR values during all time periods were greater in group RN (p= ˂0.001). Boezaart score was lower in group RN during all time periods (p= ˂0.001).
Conclusion: The Remifentanil/Nicardipine combination provides better surgical field quality for controlled hypotension (CH) in FESS. This combination is preferable over Remifentanil alone, as it not only maintains CH effectively but also shows greater success in reducing postoperative pain and nausea and vomiting scores.

Key words: controlled hypotension, Nicardipine/Remifentanil combination, surgery visual field