Factors influencing intraoperative blood loss in orthognathic surgery

Thastum, Mille Moeller; Andersen, K.N.; Rude, Kristian; Nørholt, Sven Erik; Blomlöf, Johan

doi:10.1016/j.ijom.2016.02.006

Cited by 31 publications

(31 citation statements)

References 20 publications

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“…For this reason, it is important to measure the relative blood loss during intraoperative bleeding by using a patient-specific measure. Extensive surgery and reduced body mass index are associated with increased intraoperative relative blood loss7.…”

Section: Intraoperative Complicationsmentioning

confidence: 99%

Complications associated with orthognathic surgery

Kim

2017

J Korean Assoc Oral Maxillofac Surg

111

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While most patients undergo orthognathic surgery for aesthetic purposes, aesthetic improvements are most often followed by postoperative functional complications. Therefore, patients must carefully decide whether their purpose of undergoing orthognathic surgery lies on the aesthetic side or the functional side. There is a wide variety of complications associated with orthognathic surgery. There should be a clear distinction between malpractice and complications. Complications can be resolved without any serious problems if the cause is detected early and adequate treatment provided. Oral and maxillofacial surgeons must have a full understanding of the types, causes, and treatment of complications, and should deliver this information to patients who develop these complications.

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Section: Intraoperative Complicationsmentioning

confidence: 99%

Complications associated with orthognathic surgery

Kim

2017

J Korean Assoc Oral Maxillofac Surg

111

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“…Remifentanil infusion for orthognathic surgeries is associated with a reduction in intraoperative blood loss due to its ability in lowering intraoperative blood pressure and heart rate variability, shortening the surgical duration, and postsurgical recovery times. [ 10 11 12 ] In animal studies, remifentanil infusions demonstrated dose-dependent reductions in haemodynamics (heart rate and blood pressure) and blood flows in the mandibular, masseter, tongue, upper and lower alveolar tissues. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

Is hypotensive anaesthesia guided by invasive intraarterial monitoring required for orthognathic surgery? – A retrospective review of anaesthetic practice and intraoperative blood loss in orthognathic surgery in a tertiary hospital

et al. 2021

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Background and Aims: Orthognathic surgeries for maxillofacial deformities are commonly performed globally and are associated with significant blood loss. This can distort the surgical field and necessitate blood transfusion with its concomitant risks. We aimed to review if invasive intraarterial (IA) line monitoring and/or hypotensive anaesthesia is required for orthognathic surgeries, and their effects on intraoperative blood loss and transfusion requirements. Methods: This was a retrospective observational study conducted in patients admitted for orthognathic surgeries in a public tertiary hospital. Anaesthetic techniques and intraoperative haemodynamics were studied for their effects on intraoperative blood loss. Results: The data from 269 patients who underwent orthognathic–bimaxillary surgeries was analysed. Inhalational anaesthetic combined with remifentanil was administered for 86.6%, total intravenous anesthesia to 11.2% patients, while the rest received inhalational anaesthesia. Hypotensive anaesthesia was achieved in 48 subjects (17.8%) and associated with shorter duration of surgery (349 vs 378 min, P = 0.02) and a trend towards lower blood loss (874 mL vs 1000 mL, P = 0.058) but higher transfusion requirement (81.3% vs 58.8%, P = 0.004). An IA line was used in 119 patients (44.2%) and was not associated with a higher probability of achieving hypotensive anaesthesia (19.3% vs 16.7%, P = 0.06). However, less blood loss (911 vs 1029 mL, P = 0.05) occurred compared to noninvasive blood pressure monitoring. Conclusion: Invasive blood pressure monitoring is as effective as noninvasive methods to achieve hypotensive anaesthesia. It does not aid in achieving lower target blood pressure. There is a lack of association between a reduction in blood loss and higher blood transfusion during hypotensive anaesthesiaand thiswill require further evaluation.

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“…Ueki et al [ 7 ] measured blood loss during orthognathic surgery in 62 patients, and reported that 216.6±143.3 mL of blood was lost in sagittal split ramus osteotomy procedures, while 343.6±179.9 mL of blood was lost when sagittal split ramus osteotomy was performed together with LeFort I osteotomy. In studies of factors affecting blood loss [ 8 , 9 ], higher levels of blood loss were found in procedures with a longer operation time, bimaxillary surgery or LeFort I osteotomy, patients with a relatively low body mass index, and cases involving iliac bone grafting or genioplasty. In some cases [ 10 ], blood loss exceeded 2,000 mL.…”

Section: Discussionmentioning

confidence: 99%

How to approach orthognathic surgery in patients who refuse blood transfusion

2020

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Background Some patients who need surgery refuse a blood transfusion because of their religious beliefs or concerns about blood-borne infections. In recent years, bloodless surgery has been performed successfully in many procedures, and is therefore of increasing interest in orthognathic surgery.Methods Ten Jehovah’s Witnesses who visited our bloodless surgery center for orthognathic surgery participated in this study. To maintain hemoglobin (Hb) levels above 10 g/dL before surgery, recombinant erythropoietin (rEPO) was subcutaneously administered and iron supplements were intravenously administered. During surgery, acute normovolemic hemodilution (ANH) and induced hypotensive anesthesia were used. To elevate the Hb levels to >10 g/dL after surgery, a similar method to the preoperative approach was used.Results The 10 patients comprised three men and seven women. Their average Hb level at the first visit was 11.1 g/dL. With treatment according to our protocol, the average preoperative Hb level rose to 12.01 g/dL, and the average Hb level on postoperative day 1 was 10.01 g/dL. No patients needed a blood transfusion, and all patients were discharged without any complications.Conclusions This study presents a way to manage patients who refuse blood transfusions while undergoing orthognathic surgery. rEPO and iron supplementation were used to maintain Hb levels above 10 g/dL. During surgery, blood loss was minimized by a meticulous procedure and induced hypotensive anesthesia, and intravascular volume was maintained by ANH. Our practical approach to orthognathic surgery for Jehovah’s Witnesses can be applied to the management of all patients who refuse blood transfusions.

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Factors influencing intraoperative blood loss in orthognathic surgery

Cited by 31 publications

References 20 publications

Complications associated with orthognathic surgery

Complications associated with orthognathic surgery

Is hypotensive anaesthesia guided by invasive intraarterial monitoring required for orthognathic surgery? – A retrospective review of anaesthetic practice and intraoperative blood loss in orthognathic surgery in a tertiary hospital

How to approach orthognathic surgery in patients who refuse blood transfusion

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