The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery

• Published in: Yonsei medical journal Vol. 56; no. 4; pp. 1114 - 1121
• Main Authors: Kim, Na Young, Yoo, Young-Chul, Chun, Duk-Hee, Lee, Hye Mi, Jung, Young-Soo, Bai, Sun-Joon
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.07.2015; 연세대학교의과대학
• Subjects: Administration, Oral; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - pharmacology; Adult; Aged; Anesthesia, Inhalation; Atenolol - administration & dosage; Atenolol - pharmacology; Blood Loss, Surgical; Blood Pressure - drug effects; Cardiac Output - drug effects; Double-Blind Method; Enalapril - administration & dosage; Enalapril - pharmacology; Female; Heart Rate - drug effects; Humans; Intraoperative Care; Male; Methyl Ethers - administration & dosage; Middle Aged; Original; Orthognathic Surgical Procedures; Piperidines - administration & dosage; Premedication; Treatment Outcome; 의학일반; surgical; orthognathic surgery; Atenolol; premedication; blood loss; enalapril
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2015.56.4.1114

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. 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. 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). 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.