Induced hypotension during anesthesia with special reference to orthognathic surgery

Area of Science:

• Anesthesiology
• Surgical Oncology
• Oral and Maxillofacial Surgery

Background:

• Historically, arteriotomy was used to enhance surgical field visibility.
• Concerns regarding blood transfusion-transmitted infections necessitate minimizing homologous blood transfusions.
• Induced hypotension is a technique to reduce surgical bleeding and improve visibility.

Purpose of the Study:

• To evaluate the role and safety of induced hypotension in orthognathic surgery.
• To provide recommendations for adjusting hypotensive anesthesia during these procedures.

Main Methods:

• Review of existing literature on induced hypotension in orthognathic surgery.
• Analysis of pharmacological agents used for inducing hypotension.
• Discussion of patient selection, monitoring, and fluid therapy considerations.

Main Results:

• Induced hypotension effectively reduces blood loss and improves surgical field visualization in orthognathic procedures.
• Recommended hypotensive anesthesia adjustment: 30% below usual MAP, with specific minimums (50 mm Hg for ASA Class I, 80 mm Hg for elderly).
• Recent studies show no significant increase in morbidity or mortality associated with induced hypotension.

Conclusions:

• Induced hypotension is a valuable tool in orthognathic surgery when managed appropriately.
• Anesthesia should be tailored to individual patient's preoperative blood pressure, not a fixed target.
• Careful patient evaluation, monitoring, and fluid management are crucial for safe application.