Risks and benefits of deliberate hypotension in anaesthesia: a systematic review

• Published in: International journal of oral and maxillofacial surgery 2008-08, Vol.37 (8), p.687-703
• Main Authors: Choi, W.S, Samman, N
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia - methods; Anesthesia, Dental - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Loss, Surgical - prevention & control; controlled hypotension; deliberate hypotension; Dentistry; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Hypotension, Controlled - methods; hypotensive anaesthesia; induced hypotension; Intraoperative Complications - prevention & control; Medical sciences; Oral Surgical Procedures - methods; orthognathic surgery; Otorhinolaryngology. Stomatology; Outcome and Process Assessment (Health Care); Risk Assessment; Surgery
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2008.03.011

Abstract This systematic review was performed to investigate and review the evidence on the risks and benefits of hypotensive anaesthesia in order to answer the following question: ‘Should deliberate hypotension be used routinely during orthognathic surgery?’ An electronic search on MEDLINE and the Cochrane Library database was carried out for all relevant articles using specific search keywords. All articles were classified by their levels of evidence. Studies with highest level of evidence and rated to have the lowest risk of bias were reviewed. Regarding the benefits of hypotensive anaesthesia, three studies reported significant decrease of blood loss in patients receiving hypotensive anaesthesia. Two studies reported a significant decrease in transfusion rate. Two studies demonstrated improved surgical field and significant reduction in operation time. In terms of risk, no significant changes in cerebral, cardiovascular, renal and hepatic functions in patients receiving hypotensive anaesthesia compared to control were reported. In conclusion, hypotensive anaesthesia appears to be effective in reducing blood loss. Serious consequences due to organ hypoperfusion are uncommon. Hypotensive anaesthesia can be justified as a routine procedure for orthognathic surgery especially bimaxillary osteotomy. Patient selection and appropriate monitoring are mandatory for this technique to be carried out safely.