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연세대학교 의과대학 Yonsei Medical Journal Yonsei Medical Journal 제56권 제4호
발행연도
2015.1
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1,114 - 1,121 (8page)

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Purpose: The aim of this study was to evaluate the effects of premedication with oral atenolol or enalapril, in combination with remifentanil under sevoflurane anesthesia,on intraoperative blood loss by achieving adequate deliberate hypotension (DH) during orthognathic surgery. Furthermore, we investigated the impact thereof on the amount of nitroglycerin (NTG) administered as an adjuvant agent. Materials and Methods: Seventy-three patients undergoing orthognathic surgery were randomlyallocated into one of three groups: an angiotensin converting enzyme inhibitorgroup (Group A, n=24) with enalapril 10 mg, a β blocker group (Group B, n=24) with atenolol 25 mg, or a control group (Group C, n=25) with placebo. All patientswere premedicated orally 1 h before the induction of anesthesia. NTG was the only adjuvant agent used to achieve DH when mean arterial blood pressure (MAP) was not controlled, despite the administration of the maximum remifentanil dose (0.3 μg kg-1min-1) with sevoflurane. Results: Seventy-two patients completed the study. Blood loss was significantly reduced in Group A, compared to Group C (adjustedp=0.045). Over the target range of MAP percentage during DH was significantlyhigher in Group C than in Groups A and B (adjusted p-values=0.007 and 0.006, respectively). The total amount of NTG administered was significantly less in Group A than Group C (adjusted p=0.015). Conclusion: Premedication with enalapril(10 mg) combined with remifentanil under sevoflurane anesthesia attenuated blood loss and achieved satisfactory DH during orthognathic surgery. Furthermore, the amount of NTG was reduced during the surgery.

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