Remifentanil versus labetalol for deliberate hypotensive anesthesia in children undergoing cochlear implantation: A randomized clinical trial

Background: Deliberate hypotensive anesthesia (DHA) is performed to achieve a bloodless operative field, allowing better visualization and decreasing the intraoperative blood loss amount. The present trial evaluated the efficacy of intravenous infusion (IVI) of remifentanil versus labetalol in inducing DHA in children undergoing cochlear implantation surgery. Methods: Fifty children aged from 2 to 4 years undergoing cochlear implantation surgery under general anesthesia at Al Manaa General Hospital were included in this double-blind, randomized study. Patients were randomly assigned into two equal groups. Group R: received 0.0125-0.05 mu g/kg/h remifentanil IVI after anesthesia induction. Group L: received 0.1-0.25 mg/kg/h labetalol IVI after anesthesia induction. Assessment of the quality of operative field and surgeon satisfaction were recorded. Heart rate (HR) and mean arterial blood pressure (MABP) were recorded at baseline, after intubation, then 5 minutes after the start of infusion of study drugs then every 15 minutes until the end of procedure, and for 30 minutes after recovery). Results: Quality of surgical field and surgeon satisfaction were significantly better in group R compared to group L. Good visual field was significantly better in group R compared to group L (96% vs. 72%, P = 0.049). MABP was insignificantly different between both groups at all times of measurement. HR was significantly decreased in group R compared to group L intraoperatively from 15 min till the end. Conclusion: Both remifentanil and labetalol were effective for DHA. However, remifentanil was superior to labetalol by allowing better surgical field quality and surgeon satisfaction with significant intraoperative HR reduction.