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Does Tranexamic Acid Reduce the Need for Hypotensive Anesthesia Within Orthognathic Surgery? A Retrospective Study
Chad W Dammling1, Timothy M Weber1, Kenneth J Taylor2
1Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham School of Dentistry, Birmingham, AL USA.
Journal of Maxillofacial and Oral Surgery
|April 11, 2024
Summary
Tranexamic acid (TXA) in orthognathic surgery reduces the need for hypotensive anesthesia and shortens surgery duration. This antifibrinolytic agent is safe and effective, offering benefits without associated complications.
Area of Science:
- Oral and Maxillofacial Surgery
- Anesthesiology
- Pharmacology
Background:
- Tranexamic acid (TXA) is commonly used in orthognathic surgery to reduce blood loss and enhance surgical visualization.
- Its efficacy is established with concurrent hypotensive anesthesia.
- However, concerns regarding organ hypoperfusion, cardiac ischemia, and postoperative nausea associated with hypotensive anesthesia are rising.
Purpose of the Study:
- To evaluate the efficacy and safety of using TXA without controlled hypotensive anesthesia in orthognathic surgery.
Main Methods:
- A retrospective analysis compared two cohorts undergoing bimaxillary orthognathic surgery: one with TXA and one without.
- Operative and perioperative variables were assessed.
- Intraoperative mean arterial pressure (MAP) was evaluated using descriptive and bivariate analysis.
Main Results:
- Sixty-three subjects were included in the study.
- The TXA group experienced 11.5% less time under hypotensive anesthesia compared to the control group.
- Surgical duration decreased by over 28 minutes in the TXA cohort.
- No blood transfusions or TXA-related complications were reported.
Conclusions:
- TXA is a valuable adjunct in orthognathic surgery, enabling a reduction in controlled hypotensive anesthesia.
- This approach aligns with recommendations to limit perioperative hypotensive anesthesia due to its associated risks.
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