Effect of induced hypotensive anaesthesia vs isovolaemic haemodilution on blood loss and transfusion requirements in orthognathic surgery: a prospective, single-blinded, randomized, controlled clinical study

Hypotensive Anesthesia Is Associated With Shortened Length of Hospital Stay Following Orthognathic Surgery

“…Nevertheless, the use of hypotensive anesthesia and its potential impact on shortening postoperative LOS represents not only a way of decreasing complications associated with prolonged hospital admissions, but also a way of facilitating future cost containment within an increasingly expenditureconscious medical system. Coupling this finding with the numerous other reported benefits of hypotensive anesthesia for curtailing intraoperative blood loss, 1,3-12 improving surgical field quality, [3][4][5][6]8,9,14 and lowering rates of postoperative transfusions 4,5,10,13 certainly lends credence to the use of this practice in orthognathic surgery. Ultimately, the findings of the present study will need to be corroborated by future prospective investigations designed to specifically evaluate the impact of hypotensive anesthesia on LOS.…”

“…1,2 Some of these theoretical benefits have been borne out in the literature; however, some purported benefits have not been as well substantiated. Numerous investigators have reported statistically significant associations between the use of hypotensive anesthesia in orthognathic surgery and decreased levels of intraoperative blood loss, 1,3-12 decreased rates of postoperative blood transfusions, 4,5,10,13 and an improved quality of the surgical field. [3][4][5][6]8,9,14 Conversely, the impact of hypotensive anesthesia on the duration of orthognathic surgery has not been so robustly demonstrated in the literature, with many studies failing to show statistically significant reductions in operative time compared with normotensive regimens.…”

“…Numerous investigators have reported statistically significant associations between the use of hypotensive anesthesia in orthognathic surgery and decreased levels of intraoperative blood loss, 1,3-12 decreased rates of postoperative blood transfusions, 4,5,10,13 and an improved quality of the surgical field. [3][4][5][6]8,9,14 Conversely, the impact of hypotensive anesthesia on the duration of orthognathic surgery has not been so robustly demonstrated in the literature, with many studies failing to show statistically significant reductions in operative time compared with normotensive regimens. 2,3,5,8,9,13 Nevertheless, studies on hypotensive anesthesia from other surgical disciplines have shown statistically significant decreases in operative times when deliberate hypotension is employed.…”

Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature

“…Ervens et al compared three anesthetic protocols, namely, normotensive anesthesia, hypotensive anesthesia, and hypotensive anesthesia combined with ANH, in a surgeon-blinded trial of 60 patients who required either a Le Fort I osteotomy or a bimaxillary surgery [18]. They reported that the extent of intraoperative blood loss and the requirements for an allogeneic blood transfusion were substantially reduced in those patients who underwent hypotensive anesthesia.…”

Preoperative Acute Normovolemic Hemodilution for Minimizing Allogeneic Blood Transfusion

“…16,23,25,27,28,30,33,[38][39][40][41][42][43][44][45][46][47]49,50,55,[60][61][62][63]65 These 31 studies revealed that the units of perioperative allogeneic RBC transfusion was significantly decreased in the PANH groupcompared with the control group (WMD, −0.94 units; 95% CI, −1.27 to −0.61 units; P < 0.0001). The results are presented in the forest plot in Figure 3.…”