Hematologic response to hypotensive anesthesia during orthognathic surgery
Resposta hematológica à anestesia hipotensiva durante cirurgia ortognática
Palavras-chave:
Orthognathic Surgery, Controlled Hypotension, General anestheticsResumo
Orthognathic surgery is a routine procedure with a high potential to cause hemorrhagic complications. Usually, hypotension protocols are used to stabilize and control bleeding and provide adequate surgical site visualization. The literature presents several protocols and a vast number of modifications of those, however, reports on systemic alterations due to hypotension protocols in orthognathic surgery are still scarce. In this report, the evaluation of laboratory parameters of 50 patients who underwent orthognathic surgeries was recorded before and after the surgical procedure, allowing comparison of those to normal values. While most parameters remained normal, renal clearance presented higher values, which suggests prolonged hypotension may lead to light negative effects on renal function.
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BLOOR, BYRON C. et al. Effects of Intravenous Dexmedetomidine in Humans. Anesthesiology, v. 77, n. 6, p. 1134–1142, 1 dez. 1992.
CAMPBELL, R.; RODRIGO, D.; CHEUNG, L. Asystole and bradycardia during maxillofacial surgery. Anesthesia Progress, v. 41, n. 1, p. 13–6, 1 jan. 1994.
CARLOS, E. et al. Orthognathic surgery with or without induced hypotension. International Journal of Oral and Maxillofacial Surgery, v. 43, n. 5, p. 577–580, mai. 2014.
CHEN, Y. A. et al. Pre-surgical regional blocks in orthognathic surgery: prospective study evaluating their influence on the intraoperative use of anaesthetics and blood pressure control. International Journal of Oral and Maxillofacial Surgery, v. 45, n. 6, p. 783–786, jun. 2016.
CHOI, W. S.; SAMMAN, N. Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. International Journal of Oral and Maxillofacial Surgery, v. 37, n. 8, p. 687–703, ago. 2008.
DHARIWAL, D. K. et al. Blood transfusion requirements in bimaxillary osteotomies. British Journal of Oral and Maxillofacial Surgery, v. 42, n. 3, p. 231–235, jun. 2004.
DOLMAN, R. M. et al. The effect of hypotensive anesthesia on blood loss and operative time during Le Fort I osteotomies. Journal of oral and maxillofacial surgery, v. 58, n. 8, p. 834–839, 1 ago. 2000.
ENLUND, M. et al. Induced Hypotension May Influence Blood Loss in Orthognathic Surgery, but it is not Crucial. Scand Journal of Plastic Reconstruction Surgery and Hand Surgery, v. 31, n. 4, p. 311–317, 1 jan. 1997.
ENLUND, M. et al. Occurrence of Adenylate Kinase in Cerebrospinal Fluid after Isoflurane Anaesthesia and Orthognathic Surgery. Upsala Journal of Medical Sciences, v. 101, n. 1, p. 97–112, 1 jan. 1996.
ERVENS, J. et al. Effect of induced hypotensive anaesthesia vs isovolaemic haemodilution on blood loss and transfusion requirements in orthognathic surgery: a prospective, single-blinded, randomized, controlled clinical study. International Journal of Oral and Maxillofacial Surgery, v. 39, n. 12, p. 1168–1174, dez. 2010.
FARAH, G. J. et al. Induced Hypotension in Orthognathic Surgery: A Comparative Study of 2 Pharmacological Protocols. Journal of Oral and Maxillofacial Surgery, v. 66, n. 11, p. 2261–2269, nov. 2008.
FELFERNIG-BOEHM, D. et al. Influence of Hypotensive and Normotensive Anesthesia on Platelet Aggregability and Hemostatic Markers in Orthognathic Surgery. Thrombosis Research, v. 103, n. 3, p. 185–192, ago. 2001.
FUKUNAGA, A. F.; ALEXANDER, G. E.; STARK, C. W. Characterization of the analgesic actions of adenosine: comparison of adenosine and remifentanil infusions in patients undergoing major surgical procedures. Pain, v. 101, n. 1, p. 129–138, jan. 2003.
GONG SG; KRISHNAN; WAACK D. Blood transfusions in bimaxillary orthognathic surgery: are they necessary? The International Journal of Adult Orthodontics and Orthognathic Surgery, v. 17, n. 4, p. 314–7, 1 jan. 2002.
KIANI, M. T. et al. Trigeminocardiac reflex and haemodynamic changes during Le Fort I osteotomy. International Journal of Oral and Maxillofacial surgery, v. 45, n. 5, p. 567–570, mai. 2016.
KOMATSU, R. et al. Remifentanil for general anaesthesia: a systematic review. Anaesthesia, v. 62, n. 12, p. 1266–1280, 5 nov. 2007.
LANG, S. A.; LANIGAN, D. T.; MIKE. Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. Canadian Journal of Anesthesiology, v. 38, n. 6, p. 757–760, 1 set. 1991.
MCNULTY, S.; SHARIFI-AZAD, S.; FAROLE, A. Induced hypotension with labetalol for orthognathic surgery. Journal of Oral and Maxillofacial Surgery, v. 45, n. 4, p. 309–311, abr. 1987.
NOMA, T.; TATSUYA ICHINOHE; KANEKO, Y. Inhibition of physiologic stress responses by regional nerve block during orthognathic surgery under hypotensive anesthesia. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, v. 86, n. 5, p. 511–515, 1 nov. 1998.
NOOH, N. et al. Effect of remifentanil on the hemodynamic responses and recovery profile of patients undergoing single jaw orthognathic surgery. International Journal of Oral and Maxillofacial Surgery, v. 42, n. 8, p. 988–993, ago. 2013.
PRECIOUS, D. S.; SPLINTER, W.; BOSCO, D. Induced hypotensive anesthesia for adolescent orthognathic surgery patients. Journal of Oral and Maxillofacial Surgery, v. 54, n. 6, p. 680–683, jun. 1996.
PROFFIT W.R.; TURVEY, T.A.; PHILLIPS, C. Orthognathic surgery: a hierarchy of stability. International Journal of Adult Orthodontics and Orthognathic Surgery, v. 11, n. 3, p. 191-201, jan. 1996.
RAGNO, J. R.; MARCOOT, R. M.; TAYLOR, S. E. Asystole during Le Fort I osteotomy. Journal of Oral and Maxillofacial Surgery, v. 47, n. 10, p. 1082–1083, 1 out. 1989.
SCHALLER, B. et al. The Trigemino-cardiac Reflex. Journal of Neurosurgical Anesthesiology, v. 21, n. 3, p. 187–195, 1 jul. 2009.
SIMPSON, P.; BELLAMY, D.; COLE, P. Electrocardiographic studies during hypotensive anaesthesia using sodium nitroprusside. Anaesthesia, v. 31, n. 9, p. 1172–1178, nov. 1976.
SUTTNER, S. W. et al. Cerebral effects and blood sparing efficiency of sodium nitroprusside-induced hypotension alone and in combination with acute normovolaemic haemodilution. Brazilian Journal of Anesthesiology, v. 87, n. 5, p. 699-705, nov. 2001.
YOSHIKAWA, F. et al. Blood loss and endocrine responses in hypotensive anaesthesia with sodium nitroprusside and nitroglycerin for mandibular osteotomy. International Journal of Oral and Maxillofacial Surgery, v. 38, n. 11, p. 1159–1164, 1 nov. 2009.
ZELLIN, G. et al. Evaluation of hemorrhage depressors on blood loss during orthognathic surgery: a retrospective study. Journal of Oral and Maxillofacial Surgery, v. 62, n. 6, p. 662–666, jun. 2004.
