유도 저혈압하 양악 교정술시 Remifentanil의 유용성

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.