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

Abstract

Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia.

Induced hypotension in ambulatory functional endoscopic sinus surgery: A comparison between dexmedetomidine and clonidine as premedication. A prospective, double-blind, and randomized study

“…with a MAP of 50-65 mm Hg during major maxillofacial surgeries. [ 24 ] Hypotensive anesthesia induced by using sodium nitroprusside or nitroglycerine in mandibular osteotomy to achieve MAP 60-70 mm Hg was found to be absolutely safe and associated with no significant increase in pyruvate, lactate, or glucose levels. [ 7 ]…”

Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report

“…No intraoperative blood salvage device was arranged because, although it has been demonstrated that a high percentage of patients presenting for cancer surgery actually have already circulating tumor cells, is a question yet left unanswered if adding tumor cells into the circulation could worsen prognosis [17] , [18] . During surgery, one of the best and safest way to prevent excessive bleeding, is hypotensive anesthesia (MAP to 50–65 mmHg) using propofol and remifentanil, to reduce the extent of intraoperative blood loss [18] , [19] .…”

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“…Hypotensive anesthesia is defined as reduction of systolic blood pressure to 80-90 mmHg or reduction of mean arterial pressure (MAP) by 30% from the base line [10]. As blood perfusion to the surgical site is reduced, the amount of bleeding is also reduced producing improved surgical field, less total blood loss and possibly shorter operating time [10,11]. For hypotensive anesthesia to be produced safely, only patients with good compensatory mechanisms are selected.…”