Hypotensive anesthesia: Comparing the effects of different drug combinations on mean arterial pressure, estimated blood loss, and surgery time in orthognathic surgery

Jeong, James; Portnof, Jason E.; Kalayeh, Mona; Hardigan, Patrick C.

doi:10.1016/j.jcms.2016.04.009

Cited by 13 publications

(8 citation statements)

References 8 publications

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“…These results coincided with previous work documented that hypotensive anesthesia reduced IO blood loss and improved the quality of the surgical field [21][22][23]. In line with the use of labetalol infusion for maintenance of low IO blood pressure, Hadavi et al [24] detected a little difference between labetalol and nitroglycerine on IO blood loss and surgical field quality in rhinoplasty surgery and Jeong et al [25] found sevoflurane plus a "supportive" agent either; esmolol, labetalol, metoprolol, nicardipine, and dexmedetomidine may offer significant advantage of reducing patients' MAP than sevoflurane alone during orthognathic surgery.…”

Section: Journal Of Anesthesia and Intensive Care Medicinesupporting

confidence: 89%

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2017

JAICM

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Objectives: Evaluating effect of oral labetalol pre-medication followed by low-dose intraoperative (IO) labetalol infusion on IO heart rate (HR) and mean arterial pressure (MAP), blood loss and need for transfusion and urine output (UOP) of patients undergoing open abdominal myomectomy.Patient & methods: Eighty-eight patients were randomly divided into: Study patients received 200 mg oral labetalol 2-hr before surgery and IO labetalol infusion (0.2mg/kg/hr) till completion of myomectomy. Control patients received placebo infusion and all patients received the same anesthetic protocol.Results: Operative blood loss and transfusion needs were significantly lower, but UOP was significantly higher in study than control patients. Oral labetalol significantly decreased preoperative HR and MAP of study patients compared to their baseline measures and to control patients. Oral labetalol significantly decreased HR and MAP elevations after induction and intubation compared to control patients. Labetolol infusion significantly decreased HR and MAP till stoppage of infusion compared to other measures and to control patients. Labetalol infusion allowed stability of HR and MAP with non-significant difference between measures till stoppage of infusion. Extubation significantly elevated HR and MAP in control patients, but non-significantly in study patients. Postoperative (PO), HR and MAP were significantly lower in study patients compared to baseline measures and to PO measures in control patients. PO hemoglobin concentration was significantly lower in all patients than preoperative concentrations, but concentration deficit was significantly lower in study than control patients. Conclusion:The applied protocol of labetalol hypotensive anesthesia improved anesthetic and surgical outcome of myomectomy.

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Section: Journal Of Anesthesia and Intensive Care Medicinesupporting

confidence: 89%

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2017

JAICM

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“…From the point of view of PONV prevention, use of inhalational anesthetics is suboptimal [8]. However, inhalational anesthesia remains common for orthognathic surgery in many centers; one important reason is that volatile anesthetics are preferred to induce hypotension which is frequently required to reduce intraoperative bleeding [43][44][45].…”

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confidence: 99%

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

et al. 2021

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Purpose To investigate the efficacy and safety of low-dose bolus plus continuous infusion of penehyclidine in preventing postoperative nausea and vomiting (PONV) following bimaxillary surgery. Methods Three hundred fifty-four patients were randomly allocated into three groups. In the Control group, placebo (normal saline) was injected before anesthesia and infused over 48 h after surgery; in the Bolus group, 0.5 mg penehyclidine was injected before anesthesia, whereas placebo was infused after surgery; in the Infusion group, 0.25 mg penehyclidine were injected before anesthesia, another 0.25 mg penehyclidine was infused after surgery. The primary endpoint was the incidence of PONV within 72 h. Results A total of 353 patients were included in intention-to-treat analysis. The PONV incidence was 61.0% (72/118) in the Control group, 40.2% (47/117) in the Bolus group, and 28.0% (33/118) in the Infusion group. The incidence was significantly lower in the Bolus group than in the Control group (RR 0.66; 95% CI 0.51–0.86; adjusted P = 0.003) and in the Infusion group than in the Control group (RR 0.46; 95% CI 0.33–0.63; adjusted P < 0.001); the difference between the Infusion and Bolus groups was not statistically significant (RR 0.70; 95% CI 0.48–1.00; adjusted P = 0.144). Emergence agitation occurred more frequently in the Bolus group than in the Control group (36.8% [43/117] vs. 21.2% [25/118], adjusted P = 0.027), but did not differ significantly between the Infusion and Control groups. Conclusions A low-dose bolus plus continuous infusion of penehyclidine was effective in preventing PONV without increasing emergence agitation. Trial registration Clinicaltrials.gov. Identifier: NCT04454866.

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“…In line with the use of labetalol infusion for maintenance of low IO blood pressure, Jeong et al (28) reported a significant reduction of mean arterial pressure of patients received both sevoflurane and labetalol compared to those received sevoflurane only. Moreover, Hadavi et al (29) and El-Shmaa et al (30) assured the effectiveness and safety of both labetalol and nitroglycerine infusions for controlled hypotension during rhinoplastic (29) and sinus endoscopic surgery (30). In support of efficacy of I0 labetalol, El-Shmaa et al (30) documented that labetalol infusion is more beneficial for providing mild hypotension with optimum operative condition, decreased surgical bleeding and less tachycardia during the surgery.…”

Section: Discussionmentioning

confidence: 99%