ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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)
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail spackman@uthscsa.edu
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