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Nitroglycerin-controlled circulation in orthognathic surgery.

J K Golia, R Woo, A Farole

    Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
    |May 1, 1985
    PubMed
    Summary
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    Nitroglycerin effectively controlled blood pressure during maxillary osteotomy surgery, minimizing blood loss. This study found nitroglycerin to be a safe and effective method for managing circulation in these procedures.

    Area of Science:

    • Oral and Maxillofacial Surgery
    • Anesthesiology
    • Cardiovascular Pharmacology

    Background:

    • Maxillary osteotomies carry a risk of significant blood loss.
    • Controlled hypotension is a recognized strategy to mitigate surgical bleeding.
    • Nitroglycerin offers a favorable safety profile compared to other hypotensive agents like sodium nitroprusside.

    Purpose of the Study:

    • To evaluate the efficacy and safety of nitroglycerin for controlled hypotension during maxillary and/or mandibular osteotomies.
    • To assess the impact of nitroglycerin on blood loss and physiological parameters in patients undergoing these procedures.

    Main Methods:

    • Nine patients undergoing maxillary or maxillary/mandibular osteotomies were included.
    • Anesthesia was maintained with halothane, N2O, O2, muscle relaxants, and narcotics.

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  • Nitroglycerin was administered to lower mean arterial pressure during critical surgical phases.

    • Main Results:

    • The estimated blood loss was 439 +/- 1.19 ml.
    • Hemoglobin and hematocrit showed only slight decreases, indicating minimal blood loss.
    • Nitroglycerin administration led to a decrease in PaO2, suggesting attenuation of the hypoxic pulmonary vasoconstriction reflex.

    Conclusions:

    • Nitroglycerin is a safe and effective agent for achieving controlled circulation during maxillary osteotomy surgery.
    • The use of nitroglycerin helps to minimize blood loss in these procedures.
    • Further monitoring of gas exchange is warranted when using nitroglycerin for controlled hypotension.