Remifentanil Reduces Blood Loss During Orthognathic Surgery

Abstract

Remifentanil is reported to reduce oral tissue blood flow. We performed a retrospective investigation using logistic regression analysis of anesthesia records to investigate whether the use of remifentanil infusion in a balanced anesthesia technique was useful as a primary technique to reduce blood loss during orthognathic surgery. Subjects were 80 patients who underwent Le Fort I osteotomy and sagittal split ramus osteotomy of the mandible. The variables included gender, age, weight, type of maintenance anesthetic, type and dose or infusion rate of opioid, mean systolic blood pressure (SBP-mean), coefficient of variation of systolic blood pressure (CVSBP) during surgery, mean heart rate (HR-mean), duration of surgery, total blood loss, volume of infusion used, amount of local anesthetic used, body temperature, and urine output. Gender, type of maintenance anesthetic, type of opioid, SBP-mean, CVSBP, HR-mean, and duration of surgery were used as candidates for independent variables. Logistic regression analysis was performed for the selected independent variables with the total blood loss as the dependent variable. The factors associated with the reduction of blood loss were the use of remifentanil (odds ratio, 3.112; 95% CI, 1.166-8.307; P ¼ .023) and smaller CVSBP (odds ratio, 2.747; 95% CI, 1.07-7.053; P ¼ .036). Use of remifentanil and smaller CVSBP were associated with a reduction of blood loss during 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

“…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 ]…”

Intraoperative Blood Loss and Postoperative Pain in the Sagittal Split Ramus Osteotomy and Intraoral Vertical Ramus Osteotomy: A Literature Review

“…Both the methods of anesthesia [28][29][30] and the surgical techniques [31][32][33] could affect the operation time and then control the amount of blood loss. Remifentanil is an ultrashort-acting opioid that can suppress the autonomic nervous response and produce an analgesic effect.…”

Remifentanil inhibits the traumatic stress response in emergent trauma surgery

“…Mediha TÜRKTAN and other studies have shown that intravenous target‐controlled infusion of propofol, remifentanil, and dexmedetomidine reduced intraoperative bleeding and improved surgical outcomes. Controlled hypotension with remifentanil has also been shown to be able to stabilize hemodynamics and reduce blood loss with a stable cardiac index and effective tissue perfusion …”