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

Abstract

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.

The Effect of Anesthetic Technique on Recovery After Orthognathic Surgery: A Retrospective Audit

“…It has the potential to facilitate hypotensive operating conditions without the postoperative consequences of high-dose volatile agents and morphine, and for these reasons it is increasingly being used for orthognathic surgery. 3,8 On the other hand, effective analgesia is still required in the postoperative period, 9,10 necessitating the administration of longer-acting opioids with the potential for adverse effects of perioperative opioids to occur in the postoperative period and in particular during recovery. Differences in recovery characteristics between remifentanil and other opioids have been the subject of a recent systematic review 2 ; however, in the context of maxillofacial surgery, where it may be argued that postoperative respiratory and gastrointestinal complications can be at their most dangerous, studies have been sparse.…”

The hemodynamic changes during the infusion of remifentanil for patients under sevoflurane anesthesia during arthroscopic shoulder surgery

“…It's strong analgesic effect also provides stable hemodynamic profiles throughout the surgical procedure and especially, during induced hypotensive anesthesia, it maintains cerebral blood flow reaction without complication in the major organs [15]. Choi et al reported that in the orthognathic two jaw surgeries, remifentanil 0.1 μg/kg/min while maintaining 1 MAC of sevoflurane's end-tidal concentration (ETSevo) resulted in the same induced hypotensive effect as nitroglycerin 1 μg/kg/min and rapid recovery time after discontinuation of drug infusion [16]. Degoute et al reported that induced hypotensive anesthesia with 0.2−0.5 μg/kg/min remifentanil and about 2 vol% of ETSevo in middle ear surgery decreased by 25% of middle ear blood flow with stable hemodynamics , the good surgical filed rating and no complication [17].…”