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

Ettinger, Kyle S.; Yıldırım, Yavuz Selim; Weingarten, Toby N.; Ess, James M. Van; Viozzi, Christopher F.; Arce, Kevin

doi:10.1016/j.joms.2015.05.025

Cited by 25 publications

(14 citation statements)

References 27 publications

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“…We observed that the cardiac index and ScVO 2 decreased significantly; however, these values were within normal limits and arterial blood gas results remained normal while performing CH. These findings confirmed the safety of CH from 50 to 65 mmHg in young healthy patients that was reported previously [3][4][5].…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, it provides a better surgical environment and reduces the time involved in hemostasis, thereby shortening the operative time [2]. The current data retrieved from several articles indicate that mean arterial blood pressure (MBP) within the range of 50 to 65 mmHg is safe for young and healthy patients [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Orofacial area has complex vascularization and is susceptible to excessive bleeding during orthognathic surgery [6]. For double jaw surgery, CH has remained a common method of anesthesia owing to decreased bleeding and related complications [1,4,5,7]. Several studies on drugs and monitors used during CH have been conducted to implement CH more safely [2,[7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of minimal invasive cardiac output and ScVO₂ monitoring during controlled hypotension for double-jaw surgery

Kim

Song

et al. 2019

J Dent Anesth Pain Med

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Background: Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH. Methods: We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared. Results: Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO2) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits. Conclusion: The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO2 monitoring did not present with sufficient benefits over the risk and cost.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of minimal invasive cardiac output and ScVO₂ monitoring during controlled hypotension for double-jaw surgery

Kim

Song

et al. 2019

J Dent Anesth Pain Med

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“…However, data gathered on surgery field visibility is inconsistent, assuming that subjectivity of the evaluation and different pharmacological agents' interactions may have affected the results [18,19,21,25]. Additionally, the reflection of the bleeding control on shorter surgery duration was not observed [26]. Moreover, pain is frequently observed in orthognathic surgery, therefore, adequate pain control is crucial [27].…”

Section: Methodsmentioning

confidence: 99%

Hypotensive Anaesthesia in Maxillofacial Surgery

Jackevičiūtė¹,

Kraujalytė²,

Razukevičius³

et al. 2018

Public Health

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Introduction. Deliberate hypotension (DH) is a widely used anaesthesia technique for decreasing intraoperative bleeding and improving the visibility of the operating field. Orofacial region has rich blood supply, therefore adequate bleeding management is needed. Methods. A literature search was performed using the search terms and was limited to English language. We used specific databases for our literature search. Discussion. The positive effect of DH is associated with mechanism of action leading to reduction of blood loss and reduced blood transfusion rate, accompanied by proper pain management. However, adverse effects are distinguishable, although the presentation completely depends on the hypotensive anaesthetic used for induction of DH. Conclusion. The application of controlled hypotension in maxillofacial surgery is highly advisable. Despite the positive effects, constant monitoring of the vital signs and drug induced side effects in perioperative period is needed.

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“…It has been shown that the use of deliberate hypotension can shorten the operative time, reduce the risk of tissue edema caused by ligation or electrocautery, and improve myocardial performance by reducing cardiac preload and afterload [4, 6]. A recent retrospective cohort study indicates that deliberate hypotension has a potential ability to minimize length of hospital stay for patients undergoing orthognathic surgery [7]. In 2007, moreover, a meta-analysis provides evidence to support for the use of deliberate hypotension in orthopedic surgery [8].…”

Section: Introductionmentioning

confidence: 99%

Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials

Jiang

Zhou

et al. 2019

J Orthop Surg Res

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BackgroundDeliberate hypotension has been shown to reduce the intraoperative bleeding and the need for allogeneic blood transfusion, and improve the surgical field, but there is still controversy on its clinical safety. This systematic review was designed to assess the safety and benefits of deliberate hypotension for orthopedic surgery.MethodsThe review met the requirements of the PRISMA guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, ISI Web of Science, ScienceDirect, and four Chinese databases (China National Knowledge Infrastructure, Wanfang, vip citation database, and updated version of China Biology Medicine disc from January 1, 2000 to January 1, 2019) were searched. All parallel randomized controlled trials comparing the effects of using deliberate hypotension with not using deliberate hypotension on clinical outcomes of patients undergoing orthopedic surgery were selected. The primary outcome was overall mortality. The secondary outcomes were the intraoperative blood loss, blood transfusion volume, and serious adverse postoperative events.ResultsA total of 30 studies with 36 comparisons (1454 participants) were included in meta-analysis. Two studies with 120 participants reported overall mortality and the result was zero (low-quality evidence). The use of deliberate hypotension reduced the intraoperative blood loss (mean difference, − 376.7; 95% CI − 428.1 to − 325.3; I2 = 94%; 29 studies, 36 comparisons, and 1398 participants; low-quality evidence) and blood transfusion volume (mean difference, − 242.5; 95% CI − 302.5 to − 182.6; I2 = 95%; 13 studies, 14 comparisons, and 544 participants; low-quality evidence). Six studies with 286 participants reported the occurrence of serious adverse postoperative events and the result was zero (low-quality evidence). Subgroup analyses according to age groups, controlled mean artery pressure levels, types of orthopedic surgeries, different combinations of other blood conservative method, and hypotensive methods mostly did not explain heterogeneity; significant differences were identified in almost all subgroups.ConclusionsBased on the available evidence, it is still unclear whether or not deliberate hypotension is a safe technique for orthopedic surgery due to limited studies with very small sample size, though it may decrease the intraoperative blood loss and blood transfusion volume irrespective of age groups, controlled mean artery pressure levels, types of surgeries, hypotensive methods, or different combinations of other blood conservation strategies.Trial registrationPROSPERO CRD42016045480.

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

Cited by 25 publications

References 27 publications

Efficacy of minimal invasive cardiac output and ScVO₂ monitoring during controlled hypotension for double-jaw surgery

Efficacy of minimal invasive cardiac output and ScVO₂ monitoring during controlled hypotension for double-jaw surgery

Hypotensive Anaesthesia in Maxillofacial Surgery

Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials

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

Cited by 25 publications

References 27 publications

Efficacy of minimal invasive cardiac output and ScVO2 monitoring during controlled hypotension for double-jaw surgery

Efficacy of minimal invasive cardiac output and ScVO2 monitoring during controlled hypotension for double-jaw surgery

Hypotensive Anaesthesia in Maxillofacial Surgery

Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials

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Efficacy of minimal invasive cardiac output and ScVO₂ monitoring during controlled hypotension for double-jaw surgery

Efficacy of minimal invasive cardiac output and ScVO₂ monitoring during controlled hypotension for double-jaw surgery