Comparison study between Sevoflurane/Remifentanil with Isoflurane/Remifentanil to induce hypotension in Rhinoplasty Operations

Background: Answering the question of “which modality and combination is having the upper handy?” in bleeding control during rhinoplasty surgery through controlled hypotension achieved by administering anesthesia with two different inhalation agents: sevoflurane or isoflurane, both in combination with remifentanil. Numerous studies and articles are published annually, yet the wider question regarding the efficacy of each formula has remained unaddressed. Methods: This prospective observational study utilized convenient sampling with a total of 100 patients undergoing rhinoplasty. Participants were divided into two groups: one receiving remifentanil combined with sevoflurane and the other receiving remifentanil combined with isoflurane. Controlled hypotension was achieved and monitored throughout the procedure. Results: Both anesthesia combinations effectively achieved controlled hypotension and created a dry operative field. Notably, the sevoflurane/remifentanil combination resulted in a faster onset of decreased heart rate and mean arterial blood pressure (MAP) within the first 40 minutes of the procedure compared to the isoflurane/remifentanil combination. Conclusion: The study demonstrated that both sevoflurane/remifentanil and isoflurane/remifentanil combinations are effective in controlling bleeding during rhinoplasty. Sevoflurane/remifentanil showed a quicker initial effect on cardiovascular parameters, but both protocols successfully met the primary goal of minimizing bleeding and enhancing surgical visibility.