title: The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of premedication with oral atenolol or enalapril, in combination with remifentanil under sevoflurane anesthesia, on intraoperative blood loss by achieving adequate deliberate hypotension (DH) during orthognathic surgery. Furthermore, we investigated the impact thereof on the amount of nitroglycerin (NTG) administered as an adjuvant agent.
  
  
  METHODS
  Seventy-three patients undergoing orthognathic surgery were randomly allocated into one of three groups: an angiotensin converting enzyme inhibitor group (Group A, n=24) with enalapril 10 mg, a β blocker group (Group B, n=24) with atenolol 25 mg, or a control group (Group C, n=25) with placebo. All patients were premedicated orally 1 h before the induction of anesthesia. NTG was the only adjuvant agent used to achieve DH when mean arterial blood pressure (MAP) was not controlled, despite the administration of the maximum remifentanil dose (0.3 μg kg⁻¹ min⁻¹) with sevoflurane.
  
  
  RESULTS
  Seventy-two patients completed the study. Blood loss was significantly reduced in Group A, compared to Group C (adjusted p=0.045). Over the target range of MAP percentage during DH was significantly higher in Group C than in Groups A and B (adjusted p-values=0.007 and 0.006, respectively). The total amount of NTG administered was significantly less in Group A than Group C (adjusted p=0.015).
  
  
  CONCLUSIONS
  Premedication with enalapril (10 mg) combined with remifentanil under sevoflurane anesthesia attenuated blood loss and achieved satisfactory DH during orthognathic surgery. Furthermore, the amount of NTG was reduced during the surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Na Young
authors.initials: NY
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young-Chul
authors.initials: YC
authors.lastname: Yoo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Duk-Hee
authors.initials: DH
authors.lastname: Chun
authors.affiliation: Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hye Mi
authors.initials: HM
authors.lastname: Lee
authors.affiliation: Department of Oral and Maxillofacial Surgery, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. sjbai1@yuhs.ac.
authors.forename: Sun-Joon
authors.initials: SJ
authors.lastname: Bai
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D001262:Atenolol / Q000008:administration & dosage / Q000494:pharmacology*; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004311:Double-Blind Method; D004656:Enalapril / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures; D010880:Piperidines / Q000008:administration & dosage*; D011292:Premedication; D000077208:Remifentanil; D000077149:Sevoflurane; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D001262:Atenolol; D004656:Enalapril; D000077208:Remifentanil
keywords: Atenolol; blood loss; enalapril; orthognathic surgery; premedication; surgical