Isoflurane-Induced Hypotension in Orthognathic Surgery

Lessard, Martin; Trépanier, Claude A.; Baribault, Jean-Pierre; Brochu, Jacques G.; Brousseau, Claude; Coté, Jacques J.; Denault, Pierre H.

doi:10.1213/00000539-198909000-00018

Cited by 61 publications

(53 citation statements)

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“…After detailed review of all eligible articles, 17 met the inclusion criteria. 7,12,15,[40][41][42][43][44][45][46][47][48][49][50][51][52][53] The weighted kappa on agreement between the reviewers in identifying eligible articles was 0.87, which is consistent with near perfect agreement. Reasons for excluding the potentially relevant articles included the wrong population, the wrong intervention, no control group, estimated blood loss not recorded as an outcome, subjects not randomized to treatment groups, and the article being a review or editorial.…”

Section: Resultsmentioning

confidence: 64%

“…Only one study had a perfect score of 5. 47 In addition to the tabulated methodology features, it was found that none of the studies described whether or not there was adequate allocation concealment of patient randomization. The surgical population included patients undergoing orthognathic surgery (eight studies), total hip arthroplasty (seven studies), total knee arthroplasty (one study) and spinal fusion (one study).…”

Section: Resultsmentioning

confidence: 99%

“…One study found a higher incidence of intraoperative oliguria in orthognathic surgery patients treated with isoflurane-induced hypotension; 47 by contrast, intraoperative urine output was increased in another study of hip arthroplasty patients treated with prostoglandin-induced hypotension. 53 Otherwise, none of the remaining studies found a difference in death rate, 45,48 or cerebral, 52 cardiopulmonary, 46,48,50 renal 47,52,53 or hepatic 44,52 complications. Figure 6 shows a funnel plot for the difference in blood loss between the treatment (hypotension) groups vs controls.…”

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confidence: 96%

“…The transfusion trigger was not reported in eight of the studies, 7,12,15,[41][42][43]51,52 it was left to the discretion of the attending anesthesiologist in two studies 49,50 and it was explicitly stated in the remaining seven studies. 40,[44][45][46][47][48]53 In the studies which described the transfusion triggers, the triggers included volume of blood loss (300-400 mL), hematocrit thresholds (28-30%), and percentage of blood volume lost (20%).…”

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confidence: 99%

“…Fourteen of the 17 studies advocated the use of deliberate hypotension in the discussion. 7,15,[40][41][42][45][46][47][48][49][50][51][52] Three studies reported the numbers of patients that did and did not receive any blood transfusion. 40,43,46 Overall, the incidence of receiving a blood transfusion in the hypotensive groups was 55.8% vs 78.7% in the control groups.…”

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confidence: 99%

See 4 more Smart Citations

Deliberate hypotension in orthopedic surgery reduces blood loss and transfusion requirements: A meta-analysis of randomized controlled trials

Paul

Ling

Lalonde

et al. 2007

Can J Anesth/J Can Anesth

111

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Purpose: To determine if deliberate hypotension decreases blood loss and transfusion requirements in patients undergoing orthopedic surgery, a systematic review of all randomized trials addressing this issue was undertaken.Methods: Electronic databases, citations lists and review articles were searched for potential articles. Relevant articles met the following inclusion criteria: English language, humans undergoing orthopedic surgery, deliberate hypotension used by any method, intraoperative blood loss measured as an outcome, and the trial methodology being randomized and controlled. Four outcomes were analyzed, including estimated blood loss, blood transfused, surgery duration, and quality of the surgical field. For all analyses, the random-effects model was used.Results: Seventeen articles met the inclusion criteria. The surgeries studied included total hip arthroplasty (seven), orthognathic surgery (eight), total knee arthroplasty (one) and spinal fusion (one). A total of 636 patients were randomized across all studies. For blood loss, the overall weighted mean difference favoured treatment, with a savings of about 287 mL of blood [95% confidence interval (CI): -447, -127]. The mean differences also showed a statistically significant benefit for deliberate hypotension in reducing transfusion requirements (-667 mL of blood transfused; 95% CI: -963, -370). Deliberate hypotension was not shown to reduce the duration of surgery (-1.9 min of surgery; 95% CI: -7.2, 3.5) or improve surgical conditions (surgical field quality rating -0.5; 95% CI: -1.1, 0.2). Conclusion:This review provides some support for the use of deliberate hypotension in reducing blood loss and transfusion requirements in orthopedic surgery, but these results are tempered by the small sample sizes and poor methodological quality of published studies.

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