Comparison of Hemodynamic Stability between Propofol Plus Remifentanil and Isoflorane during Middle Ear Surgery by Equal Bispectral Index Signal

Most of the middle ear surgeries are performed by using microscope and bloodless surgical field plays an important role in the vision of surgeon and consequently in the quality of surgery. There are different methods to reduce systemic blood pressure to overcome bleeding. Two of the best methods are total intravenous anesthesia (TIVA) with propofol plus remifentanil and inhalation anesthesia with isoflorane. This study aimed at comparing hemodynamic changes of these two methods of anesthesia in middle ear surgery. In this single-blinded clinical trial, 60 adults candidate for elective middle ear surgery were randomly divided into two groups: group 1 was anesthetized with isoflorane and group 2 was anesthetized with TIVA. Thereafter, the hemodynamic changes of two groups were compared during surgery with equal bispectral index system (BIS) range. There were no statistically significant differences between two groups regarding the mean arterial pressure (MAP), BIS and SaO2 as well as degree of the surgeon’s satisfaction with bleeding severity in operating field. The mean heart rate after intubation and also during surgery in group 1 was significantly higher than group 2. During middle ear surgery with BIS ranged 45±5, the degree of decrease in MAP and also the degree of surgeon’s satisfaction would not be significantly different between inhalation anesthesia (with isoflorane) and TIVA (with propofol plus remifentanil). However, a decrease in heart rate in TIVA method is more than that in the inhalation method.