악교정 수술시 유도저혈압 마취를 위해 사용되는 Esmolol과 Nitroglycerin의 효과에 대한 비교 연구

Abstract

Induced hypotension is used to help control bleeding during procedures where surgical hemostasis is technically difficult to achieve. A mean arterial blood pressure(MABP) as low as 50-60 mmHg appears to be well tolerable in healthy patients. The present study was designed to compare the efficacy of Esmolol and Nitroglycerin as primary drug for hypotensive anesthesia during 22 cases of orthognathic surgery, and compare their effects on blood loss, duration of surgery, quality of the surgical gical field, hormonal response, and patient outcome. The results obtained are as follows. 1. During the induced hypotension, mean arterial blood pressure was similarly reduced in esmolol group and nitroglycein group. And any significant difference was not seen in the time of inducing hypotension from starting the drug administration, preoperative mean blood pressure and mean blood pressure during the period of postoperative recovery. 2. Difficulty of the operation, quality of the surgical field and total operation time in 2 groups show no difference but the time during hypotension was significantly reduced in esmolol group. 3. Urine output, administered fluid volume, transfusion volume of autologous blood, preoperative and postoperative base excess, preoperative and postoperative hematocrit had no difference between 2 groups. 4. The change of the plasma renin activity was more lowered in esmolol group than in nitroglycerin group. Based on th above results, esmolol can replace the nitroglycerin as an new primary drug for hypostensive anesthesia. Especially, esmolol is more recommendable tham nitroglycerin on the effect of stability in renin-angiotensin system and prevent rebound hypertension in posthypotensive period.