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Abstract

COMPARISON OF INTRAOPERATIVE BLOOD LOSS DURING SPINAL SURGERY USING EITHER ISOFLURANE, SEVOFLURANE AND COMBINATION PROPOFOL + REMIFENTANIL AS AN ADJUVANT TO GENERAL ANESTHESIA

Amir Salari, Farahzad Jannatmakan, Kaveh Behaeen*, Ahmadreza Mohtadi, Homa Hamdan

ABSTRACT

Background: Decrease of bleeding is of significant importance in keeping the patient’s hemodynamic stabilized, and also in creating a blood-free field with a good vision for the surgeon. The purpose of this study was to compare between the three Isoflurane, Sevoflurane and Propofol+ Remifentanil drugs in terms of hemodynamic status and also bleeding in controlled hypotension, during lumbar spine surgery. Methods: This study was conducted as a randomized clinical trial among 99 patients undergone elective spinal surgery. The patients were randomly allocated into three groups. Group I: Patients received continuous infusion at a rate of 100-200 μg/kg/min propofol with 0.1 μg/kg/min Remifentanil. Group II: Patients received concentration of isoflurane between 1 to 2%. Group III: Patients received concentration of sevoflurane between 1 to 2%. The amount of hemorrhage, hemodynamic changes and Surgeon’s Satisfaction were measured and recorded. Results: There was statistically significant decrease of the bleeding in both propofol and sevoflurane groups as compared to isoflurane group(360.83 ml, 302.50 ml and 690.00 ml respectively) (p<0.001). There was no significant difference seen in the heart rate in three groups except the last time. The surgeon had 23.3% and 20.0% complete satisfaction of the patients in Sevoflurane and Propofol groups but the Surgeon was not satisfied with surgical field in none of the patients in Isoflurane group. Conclusion: The results show that, making use of Sevoflurane during spine surgery results in the least amount of hemorrhage, and non-occurrence of acute drop in hematocrit; and generally an appropriate hemodynamic stability is created without prescription of assisting drug, in comparison to application of Isoflurane, and Propofol+Remifentanil.

Keywords: Isoflurane, Propofol+Remifentanil, Sevoflurane, bleeding.


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