Surgeon satisfaction during endoscopic management of cerebrospinal fluid rhinorrhea: a comparison between propofol-remifentanil and isoflurane-remifentanil anesthesia

Surgeon's depend to a large degree on the amount of blood loss and a clear view of the surgical field, when conducting endoscopic procedures in order to achieve satisfactory outcomes. The anesthesiologist's choice of method for the induction and maintenance of anesthesia plays a major role in achieving this goal. This study was performed in order to compare the two most well-known methods in this regard; total intravenous anesthesia [TIVA] and venous inhalational mixed anesthesia [VIMA]. This study included the endoscopic management of 89 patients with cerebrospinal leakage [CSF leakage] covering a period of nine years [1999-2008] for whom a subarachnoid injection of fluorescein was first administered, and afterwards they were maintained under general anesthesia using two distinct methods; propofol-remifentanil versus isoflurane-remifentanil [inhalational or intravenous]. During the operation, hemodynamic indices, blood loss, and surgeon's satisfaction, were assessed and compared between the two groups. Endoscopic management and autografts were successful in repairing anterior skull defects in 90% of cases. Regarding the surgeon's satisfaction level, and hemodynamic stability no significant difference between the two groups was observed [P > 0.01]. Both isoflurane and propofol in combination with remifentanil afford optimal surgical conditions with regard to hemodynamic parameters and the satisfaction of the surgeon with the surgical field

[Comparison of sedative effect of remifentanil with propofol in senile cataract surgery under retrobulbar block]

As general anesthesia is not a suitable choice in elderly ASA>II patients candidate for cataract surgery performored by ophthalmology Residents and lack of cooperation in these patients, sedative effect and hemodynamic status and side effects of two drugs, Remifentanil and propofol are compared in this study. In a Randomized clinical trial 60 patient candidates for cataract surgery were divided in two groups each containing 30 patients. In group A [remifentanil group], patients were sedated with a bolus dose of 0.5 micro g/kg within 1 minute, and maintenance dose of 0.05 micro g/kg/min. In group B [propofol group], patients were sedated with a bolus dose of 0.25 micro g/kg, and maintenance dose of 25 micro g/kg/min. After retrobulbar blockage was performored on all the patients by residents, Hemodynamic responses, including HR, DBP, SBP and O2Sat and sedation level according to MOAA/SS were measured. Modified Observers Assessment of Awareness/Sedation Scale = MOAA/SS. Sedation was deeper in group A [Remifentanil] were statistically meaningful during the measured times after blockage .The heart rate was reduced in group A 20 minutes after blockage and were statistically meaningful [p<0.05]. 7 patients in group A [Remifentanil] had nausea after drug administration [P=0.011]. Remifentanil can induce high level of sedation for patients compare to propofol. But Nausea could be troublesome and in this point propofol has less adverse effect