title: Hypotensive anesthesia and recovery of cognitive function in long-term craniofacial surgery.
abstract: The aim of our study was to compare three different anesthesiological techniques with regard to hemodynamics, recovery, and postoperative morbidity, for craniofacial surgery. One hundred twenty patients with American Society of Anesthesiologists (ASA) classification of I or II patients, 18 to 32 years old, and undergoing maxillary and mandibular osteotomies were randomly assigned to receive anesthesia with propofol-remifentanil (group P), desflurane-remifentanil (group D), or sevoflurane-remifentanil (group S). All patients were given premedication: midazolam 0.03 mg/kg, atropine 0.007 mg/kg, desametasone 0.1 mg/kg, NaCl 0.9% 100 mL + 2 mg/kg ketoprofene + 1.5 mg/kg ranitidine + 1 microg/kg clonidine. Anesthesia was induced by O2/air (FiO2 0.5), remifentanil 0.5 microg/kg/min, propofol 2 mg/kg, rocuronium 0.6 mg/kg. Maintenance group P received O2/air (FiO2 0.5), remifentanil 0.25 to 1.5 microg/kg/min, propofol 6 to 10 mg/kg/h; groups D and S received O2/air (FiO2 0.5), remifentanil 0.25 to 1.5 microg/kg/min, and respectively, sevoflurane or desflurane 0.5 minimum alveolar anesthetic concentration. The dosage of propofol, desflurane, and sevoflurane, obtained with a value of bispectral index (BIS) 40, was kept unchanged throughout the course, and remifentanil was titrated to maintain controlled hypotension: systolic arterial blood pressure 70 to 90 mmHg and mean arterial blood pressure 50 to 65 mmHg. A 24-hour elastomeric infusion system (ketoprofene 320 mg) was started 60 minutes before induction and cloridrat ondansetron 0.1 mg/kg was administered 30 minutes before the end of surgery. Hypotension was successfully obtained in all three groups with a bloodless surgical field, and there was no need for additional use of a potent hypotensive agent. Early and late recovery were faster and more complete in the D group; P < 0.05. Postoperative morbidity (nausea, vomiting, shivering, pain, and edema) was slight and did not significantly differ among the groups.
authors.affiliation: Department of Anesthesiology and Resuscitation, Umberto I Polyclinic, La Sapienza University, Rome, Italy. valentina.caverni@libero.it
authors.forename: Valentina
authors.initials: V
authors.lastname: Caverni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rosa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pinto
authors.forename: Paolo
authors.initials: P
authors.lastname: Tordiglione
authors.forename: Roberto
authors.initials: R
authors.lastname: Favaro
mesh_terms: D000293:Adolescent; D000328:Adult; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000379:methods*; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D003071:Cognition; D000077335:Desflurane; D005260:Female; D017408:Guidelines as Topic; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007023:Hypotension, Controlled / Q000379:methods*; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D019647:Oral Surgical Procedures / Q000379:methods*; D056948:Orthognathic Surgical Procedures; D010880:Piperidines / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D000077208:Remifentanil; D000077149:Sevoflurane; D016037:Single-Blind Method
chemical_list: D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil; D015742:Propofol