Efficacy of Remifentanil-induced Controlled Hypotension for Orthognathic Two Jaw Surgery

Background: Controlled hypotension is used to reduce bleeding and improve surgical conditions during surgery. Remifentanil is an ultrashort-acting opioid with potent analgesic effect and is useful for rapid emergence. This study was performed to investigate the clinical usefulness of remifentanil for induced hypotension during orthognathic surgery. Methods: Fifty adult patients scheduled for orthognathic two jaw surgery were randomly allocated to nitroglycerin (group N) and remifentanil group (group R). After induction of anesthesia, group N (n = 25) was infused with nitroglycerin to induce hypotension, and group R (n = 25) was infused with remifentanil. Mean arterial pressure (MAP) and heart rate (HR) were measured before, 5, 10, 20, and 30 min after drug administration. Surgical field rating and blood loss were measured after surgery. Results: Heart rates at 10, 20, 30 minutes after continuous infusion of drug were lower in group R than in group N (P ＜ 0.05). The time for the MAP to return to the baseline after discontinuation of drug infusion was shorter in group R than in group N (P ＜ 0.05). There were no significant differences in the surgical field rating and blood loss between the groups. Conclusions: Remifentanil enabled controlled hypotension and provided good surgical conditions for orthognathic surgery with no need for additional use of a hypotensive agent. (Korean J Anesthesiol 2007; 52: 62～6)

[1]  M. Manola,et al.  Using Remifentanil and Sufentanil in Functional Endoscopic Sinus Surgery to Improve Surgical Conditions , 2005, ORL.

[2]  E. Basgul,et al.  Induced hypotension for tympanoplasty: a comparison of desflurane, isoflurane and sevoflurane , 2004, European journal of anaesthesiology.

[3]  Bong Soo Seo,et al.  Effects of Acute Normovolemic Hemodilution under Induced Hypotension on Blood Saving and Homologous Transfusion in Orthognathic Two Jaw Surgery , 2004 .

[4]  P. Papadakos,et al.  Nicardipine versus nitroprusside for deliberate hypotension during idiopathic scoliosis repair. , 2004, Journal of clinical anesthesia.

[5]  G. Geldner,et al.  Intravenous Anesthesia Provides Optimal Surgical Conditions During Microscopic and Endoscopic Sinus Surgery , 2003, The Laryngoscope.

[6]  P. Gueugniaud,et al.  Remifentanil induces consistent and sustained controlled hypotension in children during middle ear surgery , 2003, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[7]  M. Zimpfer,et al.  The Influence of Deliberate Hypotension on Splanchnic Perfusion Balance with Use of Either Isoflurane or Esmolol and Nitroglycerin , 2001, Anesthesia and analgesia.

[8]  J. Tobias,et al.  Nicardipine Versus Nitroprusside for Controlled Hypotension During Spinal Surgery in Adolescents , 1997, Anesthesia and analgesia.

[9]  W. Young,et al.  Intact Cerebral Blood Flow Reactivity During Remifentanil/Nitrous Oxide Anesthesia , 1997, Journal of neurosurgical anesthesiology.

[10]  H. Van Aken,et al.  Remifentanil: A Novel, Short-Acting, mu-Opioid , 1996, Anesthesia and analgesia.

[11]  J. Tobias,et al.  Pharmacologic drugs for controlled hypotension. , 1995, Journal of clinical anesthesia.

[12]  E. Kafer,et al.  Esmolol Is More Effective Than Sodium Nitroprusside in Reducing Blood Loss During Orthognathic Surgery , 1992, Anesthesia and analgesia.

[13]  M. C. Rogers,et al.  A Comparison of Nitroglycerin and Nitroprusside for Inducing Hypotension in Children: A Double‐blind Study , 1986, Anesthesiology.

[14]  D. Warner,et al.  Comparison of nitroprusside, nitroglycerin, and deep isoflurane anesthesia for induced hypotension. , 1985, Neurosurgery.

[15]  R. Hensinger,et al.  Hormonal and Hemodynamic Changes Induced by Pentolinium and Propranolol during Surgical Correction of Scoliosis , 1980, Anesthesiology.

[16]  C. Buffington,et al.  Blood Pressure, Not Cardiac Output, Determines Blood Loss during Induced Hypotension , 1980, Anesthesia and analgesia.

[17]  J D Michenfelder,et al.  Sodium Nitroprusside: Pharmacology, Toxicology and Therapeutics , 1976, Anesthesiology.

[18]  L. Amaranath,et al.  Tachyphylaxis to sodium nitroprusside. , 1976, Anesthesiology.

[19]  W. Gardner.  The control of bleeding during operation by induced hypotension. , 1969, Journal of the American Medical Association.

[20]  J. Guitton,et al.  Effects of posture, hypotension and locally applied vasoconstriction on the middle ear microcirculation in anaesthetized humans , 2004, European Journal of Applied Physiology and Occupational Physiology.

[21]  M. Manchon,et al.  Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[22]  C. Rodrigo,et al.  Induced hypotension during anesthesia with special reference to orthognathic surgery. , 1995, Anesthesia progress.