Salama Eman Ramadan, Amer Asmaa Fawzy
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt.
Indian J Anaesth. 2018 Mar;62(3):197-201. doi: 10.4103/ija.IJA_736_17.
Hypotensive anaesthesia is necessary in rhinoplasty for better visualisation of surgical field and reduction of surgery time. Gabapentin is a new generation anticonvulsant with anti-hyperalgesic and anti-nociceptive properties. We aimed to investigate the effect of pre-operative administration of oral gabapentin (1200 mg) on anaesthetic requirements and post-operative analgesic consumption and its role in hypotensive anaesthesia for rhinoplasty.
Seventy adult patients undergoing rhinoplasty, were randomly allocated to two groups. Group I (G I) ( = 35) received gabapentin 1.2 g and Group II (G II) ( = 35) received oral placebo capsules 2 h before surgery. General anaesthesia was maintained with sevoflurane in oxygen-nitrous oxide to maintain bispectral index value between 40 and 60, and remifentanil infusion to keep mean arterial pressure (MAP) at 55-60 mmHg. End-tidal sevoflurane concentration, intra-operative remifentanil consumption and time to intended MAP were recorded. Visual analogue scale (VAS) scores, post-operative analgesic requirements and side effects for the first 24 h were recorded.
G I required significantly lower intra-operative remifentanil (G I = 0.8 ± 0.26 mg and G II = 1.7 ± 0.42 mg; = 0.001) and end-tidal sevoflurane concentration, with reduced doses of post-operative tramadol and diclofenac sodium. Time to the intended MAP was significantly less in G I than G II (59.1 ± 12.3 vs. 73.6 ± 16.4, respectively, with = 0.001).
Pre-operative oral gabapentin significantly reduced intra-operative remifentanil and sevoflurane requirements during hypotensive anaesthesia along with decreased post-operative analgesic requirement.
在隆鼻手术中，低血压麻醉对于更好地观察手术视野和缩短手术时间是必要的。加巴喷丁是一种具有抗痛觉过敏和抗伤害感受特性的新一代抗惊厥药。我们旨在研究术前口服加巴喷丁（1200毫克）对麻醉需求和术后镇痛药物消耗的影响及其在隆鼻手术低血压麻醉中的作用。
70例接受隆鼻手术的成年患者被随机分为两组。第一组（GI）（n = 35）在手术前2小时服用1.2克加巴喷丁，第二组（GII）（n = 35）服用口服安慰剂胶囊。使用七氟醚在氧化亚氮 - 氧气中维持全身麻醉，以保持脑电双频指数值在40至60之间，并输注瑞芬太尼以使平均动脉压（MAP）维持在55 - 60 mmHg。记录呼气末七氟醚浓度、术中瑞芬太尼消耗量和达到预期MAP的时间。记录视觉模拟评分（VAS）、术后前24小时的镇痛需求和副作用。
GI组术中瑞芬太尼需求量显著低于GII组（GI组 = 0.8 ± 0.26毫克，GII组 = 1.7 ± 0.42毫克；P = 0.001），呼气末七氟醚浓度也较低，术后曲马多和双氯芬酸钠的剂量减少。GI组达到预期MAP的时间明显短于GII组（分别为59.1 ± 12.3和73.6 ± 16.4，P = 0.001）。
术前口服加巴喷丁在低血压麻醉期间显著降低了术中瑞芬太尼和七氟醚的需求量，同时减少了术后镇痛需求。
