The effect of hypotensive anesthesia on blood loss and operative time during Le Fort I osteotomies

Dolman, Robert M.; Bentley, Kenneth C.; Head, Timothy W.; English, M.J.

doi:10.1053/joms.2000.8194

Cited by 81 publications

(46 citation statements)

References 6 publications

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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: 60%

“…The most common complications were delayed wakening, blurred vision and reactionary (delayed) hemorrhage. 4,[7][8][9] Given the potential risks of this intervention, it has been reserved for healthy patients. The technique is not generally used in patients with a history of cardiac, cerebrovascular, renal, hepatic, or severe peripheral vascular disease, uncorrected hypovolemia, or severe anemia.…”

Section: Conclusion : Ce Compte-rendu Soutient Dans Une Certaine Mesumentioning

confidence: 99%

“…The results of the controlled studies are conflicting. Although there are a number of published review articles, 1,5,7,8, all suffer from major methodological limitations. 35 Lastly, none of the reviews attempted to obtain a quantitative estimate of the effect size of deliberate hypotension on blood loss and transfusion requirements.…”

Section: Conclusion : Ce Compte-rendu Soutient Dans Une Certaine Mesumentioning

confidence: 99%

“…In the studies which described the intraoperative blood pressure of the treatment group, the measured mean blood arterial ranged from 48 to 78 mmHg. 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%

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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

114

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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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Section: Resultsmentioning

confidence: 60%

Section: Conclusion : Ce Compte-rendu Soutient Dans Une Certaine Mesumentioning

confidence: 99%

Section: Conclusion : Ce Compte-rendu Soutient Dans Une Certaine Mesumentioning

confidence: 99%

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confidence: 99%

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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

114

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“…17 In another study, when intraoperative blood pressure was maintained at either normal level or decreased level in patients undergoing Le Fort I osteotomy, blood loss was found to be less in patients maintained in a hypotensive state. 18 Maintenance of hypotension has thus been identified as an important factor in reducing blood loss during surgery. In this study, however, although we found a relationship between CVSBP and blood loss, no such relationship was observed with SBP-mean, suggesting that in orthognathic surgery, it may be more important to suppress variations in systolic blood pressure rather than to lower the value of mean systolic blood pressure itself.…”

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confidence: 99%

Remifentanil Reduces Blood Loss During Orthognathic Surgery

Matsuura

Okamura

Ide

et al. 2017

Anesthesia Progress

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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.

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