Journal of The Korean Dental Society of Anesthesiology (대한치과마취과학회지)

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지

The Comparison of the Effects of Nicardipine and Remifentanil on Fluctuation of Blood Pressure during Controlled Hypotension

유도 저혈압하 양악 교정술 시 Nicardipine과 Remifentanil의 혈역학적 비교

  • Kim, Eun-Soo (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University) ;
  • Hwang, Boo-Young (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University) ;
  • Kim, Cheul-Hong (Department of Anesthesia and Pain Medicine, School of Dentistry, Pusan National University)
  • 김은수 (부산대학교 의학전문대학원 마취통증의학교실) ;
  • 황부영 (부산대학교 의학전문대학원 마취통증의학교실) ;
  • 김철홍 (부산대학교 치의학전문대학원 치과마취통증학교실)
  • Received : 2010.12.06
  • Accepted : 2010.12.21
  • Published : 2010.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Controlled hypotension is used to reduce bleeding and improve surgical conditions during surgery. Nicardipine and remifentanil have been used to induce controlled hypotension in healthy patients. This study compared controllability of nicardipine and remifentanil on hemodynamic stability during controlled hypotension. Methods: Forty healthy patients scheduled for orthognathic two jaw surgery were randomly allocated to nicardipine (group N) and remifentanil (group R) group. After induction of anesthesia, group N (n = 20) was infused with nicardipine to induce hypotension and group R (n = 20) was infused with remifentanil. Mean arterial pressure (MAP) and heart rate (HR) were measured over 5 minute interval. Surgical field rating and blood loss were measured after surgery. Results: HR was lower in group R than group N. MAP was maintained at 50-60 mmHg during controlled hypotension but the fluctuation of blood pressure and HR were more frequent in group N than group R. There were no significant differences in the surgical field rating and blood loss between the groups. Conclusions: Nicardipine and remifentanil enabled controlled hypotension and provided good surgical conditions, but the fluctuation of hemodynamic parameters was more frequent in nicardipine group.

Keywords

References

  1. Aken HV, Miller ED: Deliberate hypotension. In: Anesthesia. 5th ed. Edited by Miller RD, Cucchiara RF, Miller ED: New York, Churchill Livingstone. 1999, pp 1470-90.
  2. Andel D, Andel H, Horauf K, Felfernig D, Millesi W, zimpfer M: The influence of deliberate hypotension on splanchnic perfusion balance with use of either isoflurane or esmolol and nitroglycerin. Anesth Analg 2001; 93: 1116-20. https://doi.org/10.1097/00000539-200111000-00009
  3. Baker KZ, Ostapkovich N, Sisti MB, Warner DS, Young WL: Intact cerebral blood flow reactivity during remifentanil/nitrous oxide anesthesia. J Neurosurg Anesthesiol 1997; 9: 134-40. https://doi.org/10.1097/00008506-199704000-00005
  4. Burkle H, Dunbar S, Van Aken H: Remifentanil: a novel, short-acting, mu-opioid. Anesth Analg 1996; 83: 646-51. https://doi.org/10.1213/00000539-199609000-00038
  5. Byeon GJ, Lee HJ, Kim HK: The comparison of the effects of nitroglycerin and nicardipine on the regional blood flow during controlled hypotension. Korean J Anesthesiol 2006; 50: 519-24. https://doi.org/10.4097/kjae.2006.50.5.519
  6. Choi SH, Lee WK, Lee KY, Shin BH, Lee SJ: Efficacy of remifentanil-induced controlled hypotension for orthognathic two jaw surgery. Korean J Anesthesiol 2007; 52: 62-6. https://doi.org/10.4097/kjae.2007.52.1.62
  7. Dal D, Celiker V, Ozer E, Basgul E, Salman MA, Aypar U: Induced hypotension for tympanoplasty: a comparison of desflurane, isoflurane and sevoflurane. Eur J Anaesthsiol 2004; 21: 902-6. https://doi.org/10.1097/00003643-200411000-00012
  8. Degoute CS, Ray MJ, Gueugniaud PY, Dubreuil C: Remifentanil induces consistent and sustained controlled hypotension in children during middle ear surgery. Can J Anaesth 2003; 50: 270-6. https://doi.org/10.1007/BF03017797
  9. Donald JR: Epidural anaesthesia, induced hypotension and blood loss during surgery. Acta Anaesthesiol Scand 1983; 27: 91-3. https://doi.org/10.1111/j.1399-6576.1983.tb01912.x
  10. Gardner JW: The control of bleeding during operation by induced hypotension. JAMA 1946; 13: 572-3.
  11. Hersey SL, O'Dell NE, Lowe S, Rasmussen G, Tobias JD, Deshpande JK, et al: nicardipine versus nitroprusside for controlled hypotension during spinal surgery in adolescents. Anesth Analg 1997; 84: 1239- 44. https://doi.org/10.1213/00000539-199706000-00012
  12. Knight PR, Lane GA, Nicholls MG, Tait AR, Nahrwold ML, Hensinger RN, et al: Hormonal and hemodynamic changes induced by pentolinium and propranolol during surgical correction of scoliosis. Anesthesiology 1980; 53: 127-34. https://doi.org/10.1097/00000542-198008000-00006
  13. Lee SJ, Lee KY, Seo BS, Nam YT: Effects of acute normovolemic hemodilution under induced hypotension on blood saving and homologous transfusion in orthognathic two jaw surgery. Korean J Anesthesiol 2004; 46: 690-5. https://doi.org/10.4097/kjae.2004.46.6.690
  14. Lustik SJ, Papadakos PJ, Jackman KV, Rubery PT Jr, Kaplan KL, Chhibber AK; nicardipine versus nitroprusside for deliberate hypotension during idiopathic scoliosis repair. J Clin Anesth 2004; 16: 25-33. https://doi.org/10.1016/j.jclinane.2003.05.002
  15. Maktabi M, Waner D, Sokoll M, Boarini D, Adolphson A, Speed T, et al: Comparison of nitroprusside, nitroglycerin, and deep isoflurane anesthesia for induced hypotension. Neurosurgery 1986; 19: 350-5. https://doi.org/10.1227/00006123-198609000-00003
  16. Malcolm-Smith NA, McMaster MJ: The use of induced hypotension to control bleeding during posterior fusion for scoliosis. J Bone Joint Surg Br 1983; 65: 255-8.
  17. Rodrigo C: Induced hypotension during anesthesia with special reference to orthognathic surgery. Anesth Prog 1995; 42: 41-58.
  18. Simpson DA, Ireland J: Hypotensive and normotensive anaesthesia in total hip replacement a comparative study. Br J Clin Pract 1983; 37: 16-8.
  19. Sivarajan M, Amory DW, Everett GB, Buffington C: Blood pressure, not cardiac output, determines blood loss during induced hypotension. Anesth Analg 1980; 59: 203-6.
  20. Yaster M, Simmons RS, Rolo VT, Pepple JM, Wetzel RC, Rogers MC: A comparison of nitroglycerin and nitroprusside for inducing hypotension in children: a double-blind study. Anesthesiology 1986; 65: 175-9. https://doi.org/10.1097/00000542-198608000-00008