Acute normovolaemic haemodilution does not reduce the inflammatory process induced by facial surgery

Abstract

Acute normovolaemlc haemodilution does not reduce the inflammatory process induced by facial surgery The place of preoperative acute normovolaemic haemodilution (haematocrit = 28%-32%) in reducing postoperative inflammation was evaluated after facial surgery. Thirty-two patients scheduled for mandibular osteotomy were randomized to a nonhaemodiluted group or to a haemodiluted group. The degree of postoperative inflammation was evaluated:-first by an xray technique (radiotelemetry) providing measurements of the tissue thickness (quantitation of facial oedema), and second by the measurement of four acute phase protein plasma concentrations during the.first postoperative week. Throughout the study, no changes in facial oedema or in variation of acute phase proteins were detected after haemodilution. It is concluded that acute normovolaemic haemodilution has no effect on the intensity of facial oedema and the biological inflammation process after facial surgery. Le but de cette dtude prospective est d~valuer l'effet de lh~modilution pr~op~ratoire (h~matocrite = 28% gt 32%) sur la r~action inflammatoire aprbs chirurgie faciale. Trente-deux patients devant b~n~ficier d'une ost~otomie mandibulaire ont ~t~ ~tudi~s. Aprbs randomisation, 16 ont ~t~ h~modilu~s et 16 autres non-h~modilu~s. L'ampleur de la rdaction inflammatoire postop~ratoire a ~t~ ~valu~e gJ l'aide de deux techniques. D'une part, par tdldradiomdtrie, technique radiographique qui permet la mesure de l~paisseur des tissus mous et donc l~valuation de la r~action oed~mateuse postop~ratoire. D'autre part, par le dosage plasmatique r~p~t~ de diff~rentes prot~ines de Finflammation durant la premiere semaine postop~ratoire. Les

Perioperative Systemic Corticosteroids in Orthognathic Surgery: A Systematic Review and Meta-Analysis

“…(2)(3)(4) Some trials suggest that their use could minimize edema, but clear evidence is lacking and there is no standardized protocol. (3,5) A recent narrative review stated that there are still areas of debate in this practice. (2) Poor evidence actually support the efficacy of systemic corticosteroids in orthognathic surgery.…”

Avaliação da resposta inflamatória durante a hemodiluição normovolêmica aguda

“…Até o presente momento, muitos estudos foram conduzidos acerca de choque hemorrágico e inflamação (Rhee et al, 1998;Watters et al, 2004;Alam et al, 2004;Lee et al, 2005;Chen et al, 2005;Bahrami et al, 2006), sepse e inflamação (Zhang et al, 2003;Martins et al, 2003;Lv et al, 2006;Di Filippo et al, 2006;Feng et al, 2007;Martins et al, 2008) sendo que poucas pesquisas constam na literatura sobre hemodiluição e resposta inflamatória (Peillon et al, 1995;Wolowczyk et al, 2005). Kotake et al (2009) observaram em um estudo clínico que não houve diferenças entre as técnicas de hemodiluição normovolêmica aguda e pré-doação de sangue autólogo com relação aos mediadores inflamatórios após a transfusão de sangue previamente coletado com uma das técnicas.…”

“…Estudo conduzido por Peillon et al (1995) demonstrou que a hemodiluição normovolêmica aguda com queda de 10% de hematócrito e reposição volêmica com albumina 4%, não aumentou o processo inflamatório em cirurgias de face, mas, também não reduziu a proteína C-reativa, hepatoglobulina, ácido glicoproteíco e fibrinogênio. Wolowczyk et al, 2005 observou que a HNA não promoveu o aumento da IL-6 em pacientes submetidos ao reparo de aneurisma aórtico abdominal.…”