Desflurane versus sevoflurane to reduce blood loss in maxillofacial surgery.
OBJECTIVE
In our study, desflurane was hypothesized to reduce blood loss more than sevoflurane, both used with targeted mild controlled hypotension.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Clinica di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, G Salesi, GM Lancisi, Ancona, Italy.
Alessandro
A
Rossi
Gabriele
G
Falzetti
Abele
A
Donati
Giovanni
G
Orsetti
Paolo
P
Pelaia
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001794:Blood Pressure / Q000187:drug effects; D000077335:Desflurane; D017558:Elective Surgical Procedures; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007023:Hypotension, Controlled; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D008738:Methyl Ethers / Q000008:administration & dosage*; D016343:Monitoring, Intraoperative; D009599:Nitroprusside / Q000627:therapeutic use; D056948:Orthognathic Surgical Procedures; D010027:Osteotomy; D010880:Piperidines / Q000627:therapeutic use; D000077208:Remifentanil; D000077149:Sevoflurane; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use; D055815:Young Adult
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D010880:Piperidines; D014665:Vasodilator Agents; D009599:Nitroprusside; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil