Comparative study of the Effectiviness Among the four Types of Induced Hypotensive Anesthetic Methods in Maxillofacial Reconstructive Surgery

ABSTRACT

In the maxillofacial surgery, close care is mandatory during operation and anesthesia. The surgical field is limited since most procedure is done through the mouth. In this situation, airway management and blood pressure controls are keystone. So, the induced hypotensive anesthesia is essential to the maxillofacial surgery for bleeding control and accurate operation. One hundred and ninety-eight cases of maxillofacial surgery was carried out under induced hypotensive anesthesia from 1991 to 1999. Authors divided them into 4 groups based on the anesthetic protocol. In group 1(n = 43) inhalation anesthetics(enflurane, halothane) and sodium nitroprussde(SNP) were used; in group 2(n = 99) inhalation anesthetics(enflurane), SNP and labetalol were used; In group 3(n = 27) inhalation anesthetics(enflurane) and labetalol were used; In group 4(n = 29) total intravenous anesthesia(propofol, fentanyl, midazolam) was applied with SNP, and esmolol(or labetalol). The patient records were retrospectively studied during the operation and anesthesia, including degree of fluctuation in the mean arterial blood pressure, amounts of the blood loss and transfusion during the operation, complications, and the period of hospitalization. Mean operation time of 4 groups decreased in order. The blood pressure was controllable without reflex tachycardia in beta-blocker using groups. Amount and incidence of transfusion was smaller in total intravenous anesthesia group. However there were no significant differences in total admission days and ICU stay periods between 4 groups.