Farah Gustavo Jacobucci, de Moraes Márcio, Filho Liogi Iwaki, Pavan Angelo José, Camarini Edevaldo Tadeu, Previdelli Isolde T S, Coelho Luciano
Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil.
J Oral Maxillofac Surg. 2008 Nov;66(11):2261-9. doi: 10.1016/j.joms.2008.06.045.
The objective of this comparative study was to report on the use of 2 different pharmaceutical protocols involving 2 different anesthetic techniques (IV and balanced) to induce hypotension in patients submitted to orthognathic surgery by assessing the patients' intra- and postoperative physiologic response and hemodynamic stability.
Twenty ASA I patients, between 17 and 44 years of age who had dental and skeletal deformities were subdivided into 2 groups: group I (clonidine associated to remifentanil), and group II (dexmedetomidine associated to isoflurane), in addition, other drugs were common to both groups. The following responses were assessed: arterial blood pressure, heart rate, temperature during intra- and postoperative periods, incidence of nausea and vomiting, postoperative pain, awakening time, extubation time, and postanesthetic recovery time.
The results of the study using Repeated Measures Test statistical analysis showed that there were no significant differences between the 2 groups in respect to physiologic responses or surgery time.
Both protocols tried in this study proved to be effective and safe, and they seem to be interesting alternatives in longer orthognathic surgeries with the expectation of an important blood loss. The choice for either protocol should be based on the inherent risks involved in their use and their cost-benefit ratio.
本比较研究的目的是通过评估患者术中和术后的生理反应及血流动力学稳定性，报告在接受正颌手术的患者中使用涉及两种不同麻醉技术（静脉麻醉和平衡麻醉）的两种不同药物方案来诱导低血压的情况。
20例年龄在17至44岁之间患有牙齿和骨骼畸形的美国麻醉医师协会（ASA）I级患者被分为两组：第一组（可乐定联合瑞芬太尼）和第二组（右美托咪定联合异氟烷），此外，两组使用的其他药物相同。评估了以下反应：术中和术后的动脉血压、心率、体温、恶心和呕吐的发生率、术后疼痛、苏醒时间、拔管时间和麻醉后恢复时间。
使用重复测量检验统计分析的研究结果表明，两组在生理反应或手术时间方面没有显著差异。
本研究中尝试的两种方案均被证明是有效且安全的，对于预计有大量失血的较长时间正颌手术，它们似乎是有趣的替代方案。选择任一方案应基于其使用中涉及的固有风险及其成本效益比。
