Noma T, Ichinohe T, Kaneko Y
Department of Dental Anesthesiology, Tokyo Dental College, Japan.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Nov;86(5):511-5. doi: 10.1016/s1079-2104(98)90338-9.
The purpose of this study was to investigate the inhibitory effects of nerve block on stress responses during orthognathic surgery involving general anesthesia with induced hypotension.
Fourteen patients (ASA-1) undergoing Le Fort 1 osteotomy and sagittal splitting mandibular osteotomy were divided into 2 groups: a block group (with maxillary and mandibular nerve blocks; n = 7) and a non-block group (without nerve blocks; n = 7). Anesthesia was maintained with N2O-O2 and isoflurane (block group, 0.8%; non-block group, 1.2%). Adenosine triphosphate was administered for induced hypotension. Observed variables included hemodynamic parameters and fluctuations and adenosine triphosphate dose. Plasma norepinephrine concentrations and blood gases were observed in the block group.
More stable hemodynamics, with a lower adenosine triphosphate dose as well as negligible changes in norepinephrine concentrations and blood gases, were obtained in the block group.
The stress responses were inhibited by nerve blocks combined with low-concentration inhalation anesthesia during adenosine triphosphate-induced hypotension. The adenosine triphosphate requirement was reduced under stable hemodynamics achieved with nerve blocks.
本研究旨在探讨神经阻滞对正颌手术中全身麻醉诱导低血压期间应激反应的抑制作用。
14例（ASA-1级）接受Le Fort 1截骨术和下颌矢状劈开截骨术的患者被分为2组：阻滞组（上颌神经和下颌神经阻滞；n = 7）和非阻滞组（无神经阻滞；n = 7）。采用N2O-O2和异氟烷维持麻醉（阻滞组0.8%；非阻滞组1.2%）。使用三磷酸腺苷诱导低血压。观察变量包括血流动力学参数及波动情况和三磷酸腺苷剂量。在阻滞组观察血浆去甲肾上腺素浓度和血气。
阻滞组获得了更稳定的血流动力学，三磷酸腺苷剂量更低，去甲肾上腺素浓度和血气变化可忽略不计。
在三磷酸腺苷诱导低血压期间，神经阻滞联合低浓度吸入麻醉可抑制应激反应。通过神经阻滞实现血流动力学稳定的情况下，三磷酸腺苷需求量减少。
