Remifentanil/propofol total intravenous anesthesia versus remifentanil/isoflurane inhalation anesthesia for controlled hypotension in lumbar spine fixation surgery

Objective The aim of the present study was to design a trial to improve the control of bleeding during spine surgery by controlled hypotension achieved through maintenance of anesthesia using remifentanil with either propofol infusion or isoflurane inhalation. Patients and methods The study included 40 patients assigned for lumbar spine fixation surgery (two levels). Patients were randomly allocated into two equal groups to receive either remifentanil infusion and total intravenous anesthesia with propofol (group I) or remifentanil infusion with isoflurane inhalation anesthesia (group II). The infusion rate of propofol and MAC of isoflurane were adapted to maintain mean arterial pressure in a range of 60–70 mmHg and the heart rate at about 70 beats/ min. We compared the amount of intraoperative blood loss, the need for blood transfusion, duration of operation, and surgeon’s satisfaction of a bloodless field between both groups. Results There was no statistically significant difference between both groups in operation time (P = 0.2). The amount of intraoperative blood loss in group I was significantly lower compared with group II (P = 0.002). The total bleeding score in group I was significantly lower compared with group II (P = 0.018). Eleven patients required blood transfusion with significantly higher frequency of blood transfusion in group II [nine patients (45%)] than [two patients (10%)] in group I (P = 0.033). Mean total surgeon satisfaction score in group I was significantly higher compared with group II (P = 0.014). Conclusion Propofol/remifentanil intravenous anesthesia for spinal fixation surgery is beneficial, allowing properly controlled hypotension, minimized intraoperative bleeding, decreased need for blood transfusion, and improved surgical field visibility, compared with isoflurane/remifentanil anesthesia.