Abstract: AIM: To determine the efficacy and safety of total intravenous anesthesia of target-controlled infusion(TCI)with propofol and remifentanil during endoscopic nasal sinus surgery.METHODS: Forty ASA physical status I-II patients (male 21,female 19) aged (18-60)yr weighting (40-75)kg without heart and pulmonary disease, hypertension etal undergoing endoscopic nasal sinus surgery were randomly divided into two groups: breathing and intravenous anesthesia group (Control group, n=20) and total intravenous anesthesia group (Experiment group, n=20). Proportion of sex, age, weight operation region, ASA physical status were not different between two groups. Controlled hypotension was induced before the main procedure of surgery. All patients assigned to control group were infused by a constant infusion of 2-5 μg·kg^-1·min^-1 nitroglycerin until the target pressure was reached, then infusion rate was adapted in order to sustain hypotension. In experiment group,remifentanil were delivered with a infusion rate of 0.1-0.2 μg·kg^-1·min^-1 in order to induce controlled hypotension that was considered effective, then the rate was adapted according to hypotension. MAP was sustainted at 60-65 mm Hg(1 mm Hg=0.133 kPa) till the main procedure of surgery was finished. HR, MAP ,ECG, BIS and PETCO₂ were monitored at time of 5 minutes before anesthesia (T₁), after intubation(T₂),　15 minutes after surgical incision(T₃), 30 minutes after surgical incision(T₄),5 minutes afte controlled hypotension over(T₅),before extubation(T₆) and 3 minutes after extubation(T₇) . Blood samples were gathered from artery to detect lac concentration.　The quality of surgical field in terms of blood loss and dryness was rated by the same attending surgeon who was unware of the pharmacological treatments.RESULTS: The control group was decreased significantly than the experiment group with regard to duration of surgery and the surgical field rating (P<0.05). Controlled hypotension was achieved at the target pressure of 60-65 mm Hg within (4.7±2.7)　min,(4.4±2.5)　min for control group and experiment group respectively. Cases in control group had longer postanesthetic recovery compared with those in experiment group [(18.3±5.4)　min vs (7.0±2.1)　min,　P<0.05]. In experiment group, remifentanil induced and sustained hypotension without reflexible tachycardia and rebounding hypertension. As regard to BIS value and Lac concentration during perioperation period,there were no significant difference between two groups(P>0.05).CONCLUSION: Total intravenous anesthesia (TIVA) of target-controlled infusion(TCI)with propofol combined with remifentanil could induce and sustain controlled hypotension, reduce blood loss,during endoscopic nasal sinus surgery without reflexible tachycardia and rebounding hypertension.

Key words: Target-controlled infusion(TCI), Remifentanil, Propofol, Total venous anesthesia, Stress reaction, Nasal sinus endoscopy