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Title Induced Hypotensive Anesthesia During a Le Fort Osteotomy Decreases the Need for a Blood Transfusion
Clinical Question In an otherwise healthy patient undergoing a Le Fort Osteotomy, will hypotensive anesthesia compared to normotensive anesthesia decrease the need for a blood transfusion?
Clinical Bottom Line Hypotensive anesthesia is superior to normotensive anesthesia in reducing blood loss during a Le Fort Osteotomy, thus decreasing the need for a blood transfusion.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18511238Choi/2008Studies of patients with intentional hypotension during orthognathic surgerySystematic Review
Key results48 articles, with 22 of them being randomized clinical trials showed that during orthognathic surgeries with hypotensive anesthesia there was decreased blood loss, decreased transfusion rate, decreased operation time, and no serious risks to the rest of the body.
#2) 20961738Ervens/201060 healthy patients receiving normotensive, induced hypotensive, or induced hypotensive anesthesia with isovolaemic haemodiltuionRandomized Controlled Trial
Key resultsInduced hypotensive anesthesia alone drastically reduced blood loss, with the normotensive group having an average blood loss of 1021.63 ml whereas the hypotensive group only had an average of 392.38 ml (p < 0.05). In addition, 0 of the 21 patients needed a transfusion in the hypotensive group compared to 4 of the 19 patients in the normotensive group (p <0.05).
Evidence Search "Orthognathic Surgery" AND ("Blood Loss" OR Transfusion)
Comments on
The Evidence
The patients in all of the clinical trials were similar at the start of the procedure with a sufficient patient pool. They all had adequate follow-up. None had an obvious competing interest or bias in their trial. None of the articles conducted a meta-analysis.
Applicability This is applicable to any healthy patient having orthognathic surgery to reduce blood loss with no major risk factors.
Specialty/Discipline (Oral Surgery)
Keywords Orthognathic surgery; hypotensive anesthesia; blood loss; blood transfusion
ID# 2186
Date of submission: 04/05/2012spacer
E-mail rumple@livemail.uthscsa.edu
Author Karissa Rumple
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail spackman@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
Comments and Evidence-Based Updates on the CAT
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by Kareem Metwalli, David Bingham (San Antonio, Texas) on 11/28/2017
A PubMed search conducted in November of 2017 found a recent meta-analysis was published with regards to the effects of hypotensive anesthesia on the reduction of blood loss with orthognathic surgery patients Lin 2017 (PMID: 27542543). The results of this meta-analysis confirm the findings discussed in the above published CAT and support the original conclusions. Using ten randomized controlled trials, the meta-analysis indicated that hypotensive anesthesia reduced intra-operative blood loss. In addition, the analysis indicated that if epinephrine was used in conjunction with hypotensive anesthesia, the reduction in intra-operative blood loss was increased from 169 to 255 mL. As such, an analysis of reduced blood loss in orthognathic surgeries with hypotensive anesthesia in conjunction with other drugs seems prudent. This study, however, did not directly look at the need for blood transfusion.

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