efficacy of isoflurane-remifentanil versus propofol-remifentanil on controlled hypotension and surgeon satisfaction in rhinoplasty: a single-blind clinical trial study

Background: rhinoplasty is a complex but popular surgery in iran. the main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. this study aimed to compare the efficacy of isoflurane-remifentanil (i-r) versus propofol-remifentanil (p-r) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty. methods: in 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at mother and child hospital (shiraz, iran). patients were randomly divided into p-r (n=48) and i-r (n=50) groups. changes in systolic blood pressure (sbp), diastolic blood pressure (dbp), mean arterial pressure (map), and heart rate (hr) were assessed during surgery and in the recovery room. a questionnaire was used to evaluate the level of surgeon satisfaction. data were analyzed using independent samples t test, chi-square test, and repeated measures anova with spss software. p<0.05 was considered statistically significant.results: five minutes after anesthesia induction, the p-r combination had a greater effect on reducing sbp (p=0.010), dbp (p=0.007), map (p=0.003), and hr (p=0.026) than i-r. however, from the 40th minute to the end of surgery and after 30 minutes of recovery, the i-r combination had a slightly better effect on blood pressure reduction than p-r. there was no difference in surgeon satisfaction with either of the two drug combinations.conclusion: both p-r and i-r combinations are recommended to induce hypotension during rhinoplasty. however, i-r is more effective than p-r in inducing the desired controlled hypotension.