Comparative Evaluation of Hypotensive and Normotensive Anesthesia on LeFort I Osteotomies: A Randomized, Double-Blind, Prospective Clinical Study

Abstract

Introduction: Orthognathic surgery can account for a considerable amount of blood loss since the vascularization of maxillofacial region is such that major bleeding can occur. Intra-bony bleed is often involved as a major aspect of blood loss associated with osteotomies, especially LeFort I osteotomy when performed during orthognathic surgery. This study evolved as a result of the increasing concern to attain a clear surgical field and reduce the duration of surgical procedure and the amount of blood loss associated with orthognathic surgery with the use of controlled hypotension.

Method: Twenty patients planned for undergoing LeFort I osteotomy were randomly allocated into two groups (Group 1-normotensive anesthesia; Group 2-hypotensive anesthesia). The amount of blood loss, mean difference between hemoglobin and hematocrit in the preoperative and postoperative period, and quality of surgical field were evaluated for patients in the two groups.

Conclusion: Comparative analysis of the various parameters showed a statistically significant improvement in the hypotensive group when compared to normotensive group, although the duration of surgery and postoperative morbidity were not significantly affected when controlled hypotension was used.

Keywords: Controlled hypotension; LeFort I osteotomy; Normotensive anesthesia; Orthognathic surgery.

Conflict of interest statement

Conflict interestThe authors declare that they have no conflict of interest.

© The Association of Oral and Maxillofacial Surgeons of India 2020.

Figures

Fig. 1

Assessment of surgical site using Fromme’s scale: mean value of Fromme’s scale is higher in Group 1 which collaborates with the presence of more blood in the surgical field thus increasing the difficulty index of surgery