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The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery

 Na Young Kim  ;  Young-Chul Yoo  ;  Duk-Hee Chun  ;  Hye Mi Lee  ;  Young-Soo Jung  ;  Sun-Joon Bai 
 YONSEI MEDICAL JOURNAL, Vol.56(4) : 1114-1121, 2015 
Journal Title
Issue Date
Administration, Oral ; Adrenergic beta-Antagonists/administration & dosage ; Adrenergic beta-Antagonists/pharmacology* ; Adult ; Aged ; Anesthesia, Inhalation* ; Atenolol/administration & dosage ; Atenolol/pharmacology* ; Blood Loss, Surgical ; Blood Pressure/drug effects ; Cardiac Output/drug effects ; Double-Blind Method ; Enalapril/administration & dosage ; Enalapril/pharmacology* ; Female ; Heart Rate/drug effects ; Humans ; Intraoperative Care ; Male ; Methyl Ethers/administration & dosage* ; Middle Aged ; Orthognathic Surgical Procedures* ; Piperidines/administration & dosage* ; Premedication* ; Treatment Outcome
Atenolol ; blood loss ; enalapril ; orthognathic surgery ; premedication ; surgical
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 randomly allocated into one of three groups: an angiotensin converting enzyme inhibitor group (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 patients were 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⁻¹ min⁻¹) with sevoflurane. RESULTS: Seventy-two patients completed the study. Blood loss was significantly reduced in Group A, compared to Group C (adjusted p=0.045). Over the target range of MAP percentage during DH was significantly higher 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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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Oral and Maxillofacial Surgery (구강악안면외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Na Young(김나영) ORCID logo https://orcid.org/0000-0003-3685-2005
Bai, Sun Joon(배선준) ORCID logo https://orcid.org/0000-0001-5027-3232
Yoo, Young Chul(유영철) ORCID logo https://orcid.org/0000-0002-6334-7541
Chun, Duk Hee(전덕희)
Jung, Young Soo(정영수) ORCID logo https://orcid.org/0000-0001-5831-6508
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