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Remifentanil Reduces Blood Loss During Orthognathic Surgery
Nobuyuki Matsuura PhD, DDS,
 Taiki Okamura DDS,
 Satoko Ide PhD, DDS, and
 Tatsuya Ichinohe PhD, DDS
Article Category: Research Article
Volume/Issue: Volume 64: Issue 1
Online Publication Date: Jan 01, 2017
DOI: 10.2344/anpr-63-03-04
Page Range: 3 – 7

excessive hypotension 5 – 8 as well as an increase in the incidence of postoperative complications caused by intraoperative hypotension and prolongation of hospital stays. 9 In rabbit studies, Kemmochi et al 10 reported that remifentanil reduced blood flow in lingual mucosa and mandibular bone marrow tissue without a major decrease in blood pressure. Koshika et al 11 reported that remifentanil decreased blood flow in lingual mucosa, mandibular bone marrow tissue, masseter muscle, and maxillary and mandibular alveolar tissue in an infusion rate–dependent manner

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Hiroaki Kanbe DDS, PhD,
 Nobuyuki Matsuura DDS, PhD,
 Masataka Kasahara DDS, PhD, and
 Tatsuya Ichinohe DDS, PhD
Article Category: Other
Volume/Issue: Volume 62: Issue 2
Online Publication Date: Jan 01, 2015
Page Range: 51 – 56

another approach to control tissue blood flow in the oral region during general anesthesia. Handa et al 7 reported that hypercapnia increases common carotid artery blood flow (CCBF) and mandibular bone marrow tissue blood flow (BBF), while it decreases masseter muscle tissue blood flow (MBF). Kemmochi et al 8 reported that remifentanil (Remi) decreases CCBF and BBF without a substantial reduction of blood pressure. Koshika et al 9 reported that Remi decreases tongue mucosal blood flow (TBF), BBF, MBF, upper alveolar tissue blood flow (UBF), and lower alveolar tissue

Asako Eriguchi DDS, PhD,
 Nobuyuki Matsuura DDS, PhD,
 Yoshihiko Koukita DDS, PhD, and
 Tatsuya Ichinohe DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 68: Issue 1
Online Publication Date: Apr 07, 2021
Page Range: 10 – 18

of endogenous norepinephrine through presynaptic beta-adrenoceptor–mediated positive feedback mechanisms. 2 , 3 Therefore, the cardiovascular stimulation noted following epinephrine administration may be attributable in part to this feedback loop. Excessive cardiovascular stimulation can have deleterious effects in some patients, particularly those with hypertension and other underlying cardiovascular diseases. 4 Remifentanil is an ultrashort-acting full opioid agonist that is widely used in general anesthesia and can exhibit sympatholytic effects. 5 , 6

Kyle J. Kramer DDS, MS,
 Steven Ganzberg DMD, MS,
 Simon Prior BDS, PhD, MS, and
 Robert G. Rashid DDS, MAS
Article Category: Other
Volume/Issue: Volume 59: Issue 3
Online Publication Date: Jan 01, 2012
Page Range: 107 – 117

the depth of anesthesia in accordance with the level of surgical stimulation. Whereas the pharmacokinetic and pharmacodynamic profiles of propofol make it a nearly ideal sedative, its lack of analgesic properties often necessitates concurrent administration of IV opioids, even when local anesthesia is provided. Fentanyl, alfentanil, and remifentanil are commonly used opioid agonists that provide rapid onset, relatively short duration, and potent analgesia, all of which are useful during anesthetic induction, the injection of local anesthetic, and the stimulating

Makoto Maeno DDS, PhD,
 Ken-ichi Fukuda DDS, PhD,
 Toyoaki Sakamoto DDS, PhD,
 Yoshihiko Koukita DDS, PhD, and
 Tatsuya Ichinohe DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 63: Issue 3
Online Publication Date: Jan 01, 2016
Page Range: 116 – 121

after sevoflurane anesthesia, body movements and hemodynamic fluctuations were observed during anesthesia with propofol alone. 2 Previous reports have documented the usefulness of 3 – 6 and problems associated with 4 , 7 jointly administering an analgesic agent (eg, nitrous oxide, 4 fentanyl, remifentanil, 3 , 6 or ketamine) during propofol anesthesia to reduce or prevent adverse events and hemodynamic fluctuations. 4 , 5 , 7 However, few studies have examined the use of propofol in combination with an analgesic agent under mildly invasive surgical conditions

Figure 1.; Comparisons of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during remifentanil (Remi) infusion with those during no Remi infusion. All variables were decreased during Remi infusion when compared under identical end-tidal carbon dioxide tension (ETCO2) level. The DBP level was increased and HR was decreased along with ETCO2 elevation during Remi infusion. Data are shown as mean ± SD (n = 8). *P < .05 versus respective values at ETCO2 30 mm Hg. #P < .05 between two values at the same ETCO2 level.
Hiroaki Kanbe,
 Nobuyuki Matsuura,
 Masataka Kasahara, and
 Tatsuya Ichinohe
Figure 1.
Figure 1.

Comparisons of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during remifentanil (Remi) infusion with those during no Remi infusion. All variables were decreased during Remi infusion when compared under identical end-tidal carbon dioxide tension (ETCO2) level. The DBP level was increased and HR was decreased along with ETCO2 elevation during Remi infusion. Data are shown as mean ± SD (n = 8). *P < .05 versus respective values at ETCO2 30 mm Hg. #P < .05 between two values at the same ETCO2 level.


Soudeh Chegini,
 Kevin D Johnston,
 Athanasios Kalantzis, and
 Daljit K Dhariwal
Article Category: Research Article
Volume/Issue: Volume 59: Issue 2
Online Publication Date: Jan 01, 2012
Page Range: 69 – 74

Maxillary and mandibular osteotomies may be associated with significant blood loss and postoperative airway compromise. Deliberate hypotensive anesthesia, head up tilt, and local anesthesia with vasoconstrictor can reduce blood loss to the extent that blood transfusion is now uncommon. 1 It is, however, important to avoid excessive opioid-induced postoperative narcosis and respiratory depression associated with these techniques. Anesthetic maintenance with propofol and remifentanil is fast becoming the technique of choice for orthognathic surgery in our

Hiroaki Kanbe,
 Nobuyuki Matsuura,
 Masataka Kasahara, and
 Tatsuya Ichinohe
Figure 2.
Figure 2.

Comparisons of common carotid artery blood flow (CCBF), tongue mucosal blood flow (TBF), mandibular bone marrow tissue blood flow (BBF), upper alveolar tissue blood flow (UBF), lower alveolar tissue blood flow (LBF), and masseter muscle tissue blood flow (MBF) during remifentanil (Remi) infusion with those during no Remi infusion. All variables were decreased during Remi infusion when compared under identical end-tidal carbon dioxide tension (ETCO2) level. The BBF, UBF, and LBF values were increased and MBF was decreased along with ETCO2 elevation during Remi infusion. Data are shown as mean ± SD (n = 8). *P < .05 versus respective values at ETCO2 30 mm Hg. #P < .05 between 2 values at the same ETCO2 level.


Yoshiki Shionoya DDS, PhD,
 Maki Yamamoto DDS,
 Katsuhisa Sunada DDS, PhD, and
 Kiminari Nakamura DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 67: Issue 1
Online Publication Date: Jan 01, 2020
Page Range: 45 – 47

nasal cavity. Tracheal intubation was performed without any muscle relaxants, with the use of sevoflurane (3%) and a continuous infusion of remifentanil (0.3 μg/kg/min). General anesthesia was subsequently maintained with desflurane (4–5%), oxygen (1 L/min), and air (2 L/min) in addition to remifentanil (0.15–0.2 μg/kg/min). Local anesthesia was administered via buccal infiltration of the left posterior maxillary and mandibular regions using 3.6 mL of 2% lidocaine (72 mg) with 1:80,000 epinephrine (0.045 mg). The surgical procedure was completed uneventfully and the

Yukiko Nishioka DDS, PhD,
 Saki Miyake DDS, PhD,
 Midori Hamaoka DDS,
 Kota Miyake DDS,
 Maki Fujimoto DDS, PhD,
 Hitoshi Higuchi DDS, PhD, and
 Takuya Miyawaki DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
Page Range: 65 – 69

remifentanil at 0.25 μg/kg/min along with 100% oxygen (6 L/min) via facemask. After the patient lost consciousness, the remimazolam infusion rate was decreased to 1 mg/kg/h. Neuromuscular blockade was performed with an IV bolus of rocuronium (25 mg), and nasotracheal intubation was successfully performed without difficulty. Before tracheal intubation, the patient's lowest BP and HR were 118/55 mm Hg and 62 bpm, respectively. There were no significant hemodynamic changes during induction or after tracheal intubation. General anesthesia was maintained with continuous infusions