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Controlled Hypotension Agent Choice — FRCA Final MCQ

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ModerateGeneral AnaesthesiaControlled Hypotension Agent ChoiceFRCA Final

A 42-year-old woman (ASA II) is having a posterior spinal fusion T10-L5. The surgeon requests deliberate hypotension. Which agent provides the most titratable controlled hypotension with rapid offset?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Remifentanil infusion

Remifentanil infusion provides the most titratable controlled hypotension with the most rapid offset (context-sensitive half-time ~3 minutes regardless of infusion duration). It reduces MAP through centrally-mediated sympatholysis and bradycardia. SNP is also rapidly titratable but carries risks of cyanide toxicity, rebound hypertension, and tachyphylaxis. Remifentanil is now preferred over SNP in most centres for intraoperative controlled hypotension.

Reference: RCOA – 2023 – Final FRCA curriculum: controlled hypotension; Peck TE – 2014 – Pharmacology