Department of Oral and Maxillofacial Surgery, Dental College, King Saud University, Riyadh, Saudi Arabia.
Int J Oral Maxillofac Surg. 2013 Aug;42(8):988-93. doi: 10.1016/j.ijom.2013.02.001. Epub 2013 Mar 13.
The aim of this study was to compare fentanyl-based versus remifentanil-based anesthesia with regards to the intraoperative hemodynamic stress response and recovery profiles in patients undergoing Le Fort I osteotomy. Seventeen patients were randomly divided into two groups: patients in the F-group received 2 μg/kg fentanyl intravenously followed by an infusion of 0.03-0.06 μg/kg/min, while patients in the R-group received a 0.5 μg/kg bolus of remifentanil followed by an infusion of 0.0625-0.250 μg/kg/min. Mean arterial pressure and heart rate were recorded at the following points: before anesthetic induction, at endotracheal intubation, 5 min after intubation, at incision, just before the osteotomy, during the osteotomy, during the maxillary fracturing, at suturing, at extubation, 5 min after extubation, and then 15 and 30 min postoperatively. Heart rate and mean arterial pressure were significantly lower in the R-group in comparison to the F-group from t1 to t9 (P<0.05). All measured recovery times were significantly shorter in the R-group (P<0.05). The incidence of postoperative side effects was comparable between groups. Remifentanil-based anesthesia is an appropriate alternative to fentanyl during Le Fort I orthognathic surgery; it promotes hemodynamic stability, blunts the stress response to noxious stimuli, and provides a better recovery profile.
本研究旨在比较芬太尼与瑞芬太尼麻醉在 Le Fort I 截骨术中对患者术中血流动力学应激反应和恢复特征的影响。17 例患者随机分为两组：F 组患者静脉注射 2μg/kg 芬太尼，然后以 0.03-0.06μg/kg/min 的速度输注；R 组患者给予 0.5μg/kg 瑞芬太尼推注，然后以 0.0625-0.250μg/kg/min 的速度输注。记录以下各点的平均动脉压和心率：麻醉诱导前、气管插管时、插管后 5min、切口时、截骨前、截骨时、上颌骨骨折时、缝合时、拔管时、拔管后 5min，然后术后 15min 和 30min。与 F 组相比，R 组在 t1 至 t9 时心率和平均动脉压显著降低（P<0.05）。R 组所有测量的恢复时间均显著缩短（P<0.05）。两组术后不良反应发生率相当。瑞芬太尼麻醉是 Le Fort I 正颌手术中替代芬太尼的一种合适选择；它可促进血流动力学稳定，减轻对有害刺激的应激反应，并提供更好的恢复特征。
