Orthognathic surgery requires a balancing act in anesthetic technique

American Dental Society of AnesthesiologyJul 27 2012

Orthognathic surgery, affecting the jaws and face, requires a balancing act in anesthetic technique. Limiting blood loss, avoiding respiratory depression, and averting postoperative nausea and vomiting lead to optimum patient outcomes. The use of the drugs propofol and remifentanil are increasing because they can meet these needs; however, patients may subsequently experience more postoperative pain.

The journal Anesthesia Progress presents a retrospective study of 51 patients in a single medical center. The 21 orthognathic maxillofacial surgery patients in the group receiving intravenous propofol and remifentanil experienced significantly higher pain scores. Anesthesia for the 30 patients in the comparison group was maintained with inhalational agents and longer-acting opioids.

The drug remifentanil is seeing increased use in orthognathic surgery because its short half-life can facilitate stable operating conditions while avoiding the undesirable postoperative consequences of morphine and other such agents. There is still a need for pain control in the postoperative period using longer-acting opioids that carry a greater potential for adverse effects.

The study was undertaken to ensure that achieving better intraoperative conditions did not come at the expense of patients' recovery. Variables of comparison included recovery time, occurrence of nausea and vomiting, pain scores, heart rate, and opioid dose administered in the 4 hours following surgery.

There was a trend toward shorter recovery times in the group receiving propofol and remifentanil. The median recovery time was 65 minutes for this group and 93 minutes for the inhalation group. However, the first group reported higher pain scores in the first 4 hours following surgery. No differences were found in early postoperative opioid use, heart rate, or nausea and vomiting.

With maxillofacial surgery, postoperative respiratory and gastrointestinal complications can be dangerous. While turning to drugs that can reduce these risks leads to better surgical experiences, it may also mean increased postoperative pain for patients. This study takes a first look at this occurrence and may be the stimulus for future controlled studies.