Abstract
BackgroundPatients with maxillofacial deformities require orthognathic surgeries to correct occlusion. The surgical procedure may lead to massive bleeding, which is associated with haematoma, respiratory obstruction, and asphyxia. Dexmedetomidine has been used in controlled hypotension and may reduce blood loss in orthognathic surgery. We conducted a retrospective cohort study to evaluate the effect of dexmedetomidine on blood loss in orthognathic surgeries.MethodsThe primary outcome examined was blood loss, and secondary outcomes were postoperative haemoglobin level; intraoperative heart rate and blood pressure (T1: at incision; T2: 30 min after incision; T3: 60 min after incision; T4: 120 min after incision); dosage of fentanyl, remifentanil, urapidil, and esmolol; operation time; and incidence of allogeneic blood transfusion.ResultsA total of 1247 patients were included in this study, and 540 patient pairs were matched via propensity score matching. There were significant decreases in mean blood loss, heart rate at T1–T4, blood pressure at T1, and remifentanil and esmolol dosage in the dexmedetomidine group compared with those in the control group. There was also a significant increase in the postoperative haemoglobin level of the dexmedetomidine group.ConclusionsContinuous infusion of dexmedetomidine can decrease blood loss in orthognathic surgery.Trial registration: ChiCTR1800018794 (retrospectively registered)Name of registry: Chinese Clinical Trial RegistryDate of registration: 2018/10/09URL: www.chictr.org.cn/showproj.aspx?proj=30612
Highlights
Patients with maxillofacial deformities require orthognathic surgeries to correct occlusion
The rich blood supply and deep surgical site of the oral and maxillofacial region often lead to increased bleeding and a limited visual field during osteotomy of the maxilla, increasing the risk posed by surgery
After the researchers checked the medical records, five patients were excluded because infusions of dexmedetomidine were discontinued during operations
Summary
Patients with maxillofacial deformities require orthognathic surgeries to correct occlusion. The surgical procedure may lead to massive bleeding, which is associated with haematoma, respiratory obstruction, and asphyxia. Dexmedetomidine has been used in controlled hypotension and may reduce blood loss in orthognathic surgery. Patients with maxillofacial deformities require orthognathic surgeries (among others, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy) to correct occlusions or their physical appearance [1, 2]. The rich blood supply and deep surgical site of the oral and maxillofacial region often lead to increased bleeding and a limited visual field during osteotomy of the maxilla, increasing the risk posed by surgery. Dexmedetomidine is a potent, highly selective α2adrenoceptor agonist that may provide anti-sympathetic analgesia and sedation without respiratory depression [7], and it has been successfully used for controlled hypotension in other surgical procedures [8]
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