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Isoflurane-induced hypotension in orthognathic surgery
M R Lessard1, C A Trépanier, J P Baribault
1Département d'anesthésie, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Canada.
Anesthesia and Analgesia
|September 1, 1989
Summary
Isoflurane-induced hypotension significantly reduces blood loss and transfusion needs in orthognathic surgery. However, it did not affect operative time or postoperative edema.
Area of Science:
- Anesthesiology
- Oral and Maxillofacial Surgery
Background:
- Orthognathic surgery, such as combined maxillary and mandibular osteotomies, can involve significant blood loss.
- Maintaining a clear surgical field and managing postoperative edema are critical aspects of patient care.
Purpose of the Study:
- To investigate the effects of isoflurane-induced deliberate hypotension on blood loss, surgical field quality, and postoperative edema in patients undergoing combined maxillary and mandibular osteotomies.
Main Methods:
- Fifty-two patients were divided into a hypotensive group (mean arterial pressure [MAP] 55-65 mm Hg) and a control group (MAP 75-85 mm Hg).
- Anesthesia was maintained using fentanyl, nitrous oxide (N2O), oxygen (O2), and isoflurane, with hypotension induced by increasing isoflurane concentration.
Main Results:
- The hypotensive group experienced significantly less blood loss (454.0 +/- 211.3 mL vs. 755.3 +/- 334.6 mL; P < 0.001).
- Fewer patients in the hypotensive group required blood transfusions (12.0% vs. 44.4%; P < 0.02).
- The surgical field was significantly improved, but operative time was not reduced. Postoperative edema showed no significant difference between groups.
Conclusions:
- Isoflurane-induced deliberate hypotension is an effective method for reducing blood loss and transfusion requirements in orthognathic surgery.
- While improving the surgical field, this technique does not appear to impact operative time or postoperative edema.