Rossi Alessandro, Falzetti Gabriele, Donati Abele, Orsetti Giovanni, Pelaia Paolo
Clinica di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, G Salesi, GM Lancisi, Ancona, Italy.
J Oral Maxillofac Surg. 2010 May;68(5):1007-12. doi: 10.1016/j.joms.2008.12.012. Epub 2010 Feb 13.
In our study, desflurane was hypothesized to reduce blood loss more than sevoflurane, both used with targeted mild controlled hypotension.
A total of 20 American Society of Anesthesiologists Class I patients undergoing maxillofacial elective surgery for maxillary and mandibular osteotomies were randomized to a desflurane group or a sevoflurane group. Anesthesia was performed with an end tidal value of the inhaled agent to obtain a bispectral index value <30 but without burst-suppression patterns (minimal alveolar concentration age-corrected between 0.7 and 0.9). Remifentanil was administered at a dose of 0.5 microg x kg(-1) x min(-1) to obtain analgesia and a <2 surgical field level in Fromme's modified scale. Sodium-nitroprusside was administered on demand to have a surgical field level of <2 when the anesthesia plan was not sufficient to achieve this target. The minimal value of the mean arterial pressure achievable was 60 mm Hg.
In the desflurane group, blood loss was more restricted. The hypotensive drug was used in 8 patients in the sevoflurane group and 2 patients in the desflurane group.
Anesthesia with desflurane can reduce blood loss and could give an acceptable surgical field with mild controlled hypotension and with a substantial reduction in the vasoactive drug requirement. These data need to be assessed with an enlargement of the statistical sample.
在我们的研究中，假设与七氟醚相比，地氟醚在用于目标性轻度控制性低血压时能减少失血。
总共20例美国麻醉医师协会I级患者接受上颌骨和下颌骨截骨术的颌面择期手术，被随机分为地氟醚组或七氟醚组。采用吸入麻醉药的呼气末浓度进行麻醉，以获得脑电双频指数值<30但无爆发抑制模式（年龄校正后的最低肺泡浓度在0.7至0.9之间）。瑞芬太尼以0.5μg·kg⁻¹·min⁻¹的剂量给药以获得镇痛效果，并使Fromme改良量表中的手术野水平<2。当麻醉方案不足以达到该目标时，按需给予硝普钠以使手术野水平<2。可达到的平均动脉压最小值为60mmHg。
在地氟醚组中，失血更受限制。七氟醚组有8例患者使用了降压药，地氟醚组有2例患者使用了降压药。
地氟醚麻醉可减少失血，在轻度控制性低血压情况下可提供可接受的手术视野，并大幅减少血管活性药物的需求。这些数据需要通过扩大统计样本进行评估。
