Effects of Controlled Hypotension on Cerebral Oxygenation in Tympanoplasty and Tympanomastoidectomy Surgery

Background: Controlled hypotension can reduce bleeding and improve visualization of the surgical field. We aimed to evaluate the effects of deliberate controlled hypotension by using esmolol and nicardipine on cerebral oxygenation, hemodynamics, bleeding, surgical satisfaction and quality of recovery. Methods: Sixty patients between the ages of 18 and 65 who were scheduled tympanomastoidectomy surgery were included. Anesthesia induction was performed with propofol, rocuronium and general anesthesia was maintained with sevoflurane and remifentanil infusion. The mean arterial blood pressure was aimed to be <30% from baseline for controlled hypotension. Nicardipine infusion (1-5 µg/kg/min) was used in group N and Esmolol infusion (30-300 µg/kg/min) was used in group E. Surgical bleeding and surgical satisfaction, extubation and recovery time, postoperative side effects, antiemetic and additional analgesic medications were recorded. Results: There was no difference between the groups in demographic data, duration of anaesthesia, extubation time, recovery time, Aldrette recovery scores, and the use of antiemetic and additional analgesics. The NIRS values in N group were observed higher than E group at the 20th and 40th minutes on the left, and at the 25th, 30th, 35th, 40th, 45th and 60th minutes on the right (p<0.05). Mean arterial blood pressure at the 70th and 80th minutes, and heart rate at the 15th, 25th, 30th, 35th and 40th minutes were observed higher in N group when compared to the E group. In the esmolol group, it was observed mild bleeding in 23 patients, moderate bleeding in 7 patients. In the nicardipine group, it was observed mild bleeding in 11 patients, moderate bleeding in 18 patients, severe bleeding in 1 patient. Surgeon’s satisfaction was higher in the Esmolol group (p<0.05). Conclusion: It was concluded that both Nicardipine and Esmolol could be applied for controlled hypotension during the otologic surgery, cerebral oxygenation was maintained with at doses administered Nicardipine and Esmolol in sevoflurane-remifentanil anesthesia. Surgical bleeding was lesser and surgeon’s satisfaction was higher with the Esmolol group than the Nicardipine group.