Add time:09/29/2019         Source:infona.pl

Induced hypotensive anesthesia is very applicable to oral surgery, especially orthognathic surgery, because blood loss in these operations is often severe enough that the patient needs a blood transfusion, and because bleeding during surgery interferes with the accurate performance of the operation. In recent years, therefore, we have been using such potent vasodilators as trimethaphan (TMP) and adenosine triphosphate (ATP).The reduction of oral-tissue blood flow and the maintenance of blood flow to the vital organs should be satisfied simultaneously in induced hypotensive anesthesia. For this reason, cardiac output and arterial oxygen tension (PaO 2 ) should be maintained in spite of the decrease in blood pressure. However, there are no clinical reports examining the appropriate combination of vasodilators and volatile anesthetics for these purposes.In this study, the use of three drug combinations of vasodilators and volatile anesthetics (halothane-TMP, halothane-ATP, and isoflurane-ATP) to deliberately induce hypotensive anesthesia with systolic blood pressure at 70 torr was investigated to determine the most appropriate drug combination for use in oral surgery.Twenty-five consenting patients undergoing orthognathic surgery classified ASA physical status I were divided into three groups: N 2 O-halothane-TMP (H-T, n = 8), N 2 O-halothane-ATP (H-A, n = 8), and N 2 O-isoflurane-ATP (I-A, n = 9). Following the control measurements, systolic blood pressure was reduced to 70 torr, and the parameters were measured again. In the H-A and I-A groups, dipyridamole 0.2 mg/kg was administered before ATP infusion, and another measurement was performed 2 min later.Electrocardiogram (lead CS 5 ), heart rate, direct blood pressure, cardiac index, and blood gas were investigated, and the stroke volume index and total peripheral resistance index were calculated.(1) In the H-T group, the heart rate and cardiac index remained unchanged during hypotension (Figure 1).(2) In the H-A and I-A groups, the heart rate and cardiac index increased during hypotension. Isoflurane depressed cardiac function less than halothane did.(3) In the I-A group, the diastolic blood pressure and mean arterial pressure were lower than in the H-A group.(4) There were no PaO 2 reductions in any of the three groups.These results suggest that, because cardiac output and PaO 2 are maintained during hypotension, isoflurane-ATP-induced hypotension is the most appropriate for oral surgery unless the decrease in diastolic blood pressure causes a reduction in coronary blood flow.

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