Remifentanil versus Nitroglycerin for Controlled Hypotensive Anesthesia During Primary Open Rhinoplasty: A Comparative Study

Background: Controlled hypotensive anesthesia is commonly utilized to reduce blood loss and provide a desirable surgical field during perioperative procedures, particularly in facial plastic operations. Objective: To assess the hypotensive effects of nitroglycerine and remifentanil for controlled hypotension anesthesia in primary open rhinoplasty. Methods: A prospective, comparative, randomized, double-blind study was carried out from June to October 2021 at Rizgary Teaching Hospital in Erbil, Iraq. Eighty patients were randomly divided into two groups and given either nitroglycerin or remifentanil to keep their mean arterial blood pressure between 50 and 60 mmHg. Heart rate, systolic and diastolic blood pressure, intraoperative blood loss, surgical field quality, and surgery duration are all measured and compared. Results: Patients in the nitroglycerin and remifentanil groups met the systolic, diastolic, and mean arterial pressure objectives with similar results. However, there is a statistically significant difference in operation duration between the remifentanil and nitroglycerin groups (135.3 and 145.3 minutes, respectively). The heart rate differed significantly between the two groups. The remifentanil group had decreased intraoperative blood loss, a higher surgical field quality, and significantly greater surgeon satisfaction. Conclusions: Continuous infusion of nitroglycerine and remifentanil is a dependable and effective method for achieving controlled hypotension by reaching the target mean arterial pressure. Remifentanil outperforms nitroglycerin in terms of limiting blood loss, reducing surgical time, and maintaining superior hemodynamics (particularly heart rate).