# Perioperative effects of different hypotensive anesthesia techniques in orthognathic surgery

## TL;DR

This study compared different hypotensive anesthesia techniques during orthognathic surgery and found they all effectively reduced bleeding without major differences in outcomes.

## Contribution

The study evaluates three hypotensive anesthesia combinations for orthognathic surgery, providing evidence for their comparable effectiveness.

## Key findings

- Bleeding volume, surgery satisfaction, and operation time were similar across all three groups.
- Group 3 had significantly higher heart rates intraoperatively compared to Groups 1 and 2.
- Postoperative analgesic use, pain levels, and blood pressure were not significantly different between groups.

## Abstract

This study aimed to investigate the effectiveness of combining sevoflurane with remifentanil, esmolol, or nitroglycerin for hypotensive anesthesia and determine the suiTable hypotensive anesthesia method for orthognathic surgery.

This retrospective study included 60 patients who underwent orthognathic surgery for developmental malocclusion. They were divided into three groups based on the hypotensive agent preferences: Group 1 (n = 20), sevoflurane and remifentanil; Group 2 (n = 20), sevoflurane and esmolol; Group 3 (n = 20), sevoflurane and nitroglycerin. Bleeding volume, heart rate, systolic, diastolic, and mean arterial blood pressure were recorded at certain times during the perioperative period, including at stages with increased stress levels in the body, such as incision and osteotomy. The patients’ blood pressure, analgesic consumption and pain level were recorded in the postoperative period.

Bleeding volume, surgery satisfaction related to bleeding, and total operation time did not differ significantly between groups. Intraoperatively, heart rates were significantly higher in Group 3 than in Groups 1 and 2 (p = 0.001). However, hemodynamic stability was similar in Groups 1 and 2. Postoperatively, analgesic consumption, pain levels, and blood pressure dynamics did not differ significantly between groups (p > 0.05).

Based on this study’s results, it was concluded that infusing remifentanil, esmolol, or nitroglycerin with sevoflurane during orthognathic surgery successfully achieved the targeted hypotensive anesthesia and can be considered alternative methods. The decision on which method to use should consider the patient’s overall health status and additional medical conditions.

Key words:Orthognathic surgery controlled hypotensive anesthesia, remifentanil, esmolol, nitroglycerin, sevoflurane, surgeon satisfaction, bleeding.