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Journal of Maxillofacial and Oral Surgery

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25-02-2024 | Tranexamic Acid | ORIGINAL ARTICLE

Does Tranexamic Acid Reduce the Need for Hypotensive Anesthesia Within Orthognathic Surgery? A Retrospective Study

Authors: Chad W. Dammling, Timothy M. Weber Jr., Kenneth J. Taylor, Brian E. Kinard

Published in: Journal of Maxillofacial and Oral Surgery | Issue 2/2024

Abstract

Background

Tranexamic acid (TXA) is utilized frequently in orthognathic surgery to limit blood loss and improve surgical field visualization. This antifibrinolytic has been proven effective with use of concomitant hypotensive anesthesia. Despite proven efficacy, there is a recent push to avoid perioperative hypotensive anesthesia due to risks of organ hypoperfusion, cardiac ischemia and postoperative nausea.

Aims

The aim is to study the efficacy and safety of utilizing TXA without controlled hypotensive anesthesia.

Methods

The authors identified two cohorts of subjects that underwent bimaxillary orthognathic surgery both with and without TXA administration and compared operative and perioperative variables. A retrospective analysis was completed evaluating intraoperative MAP measurements in subjects treated both with and without TXA using descriptive and bivariate analysis.

Results and conclusion

Sixty-three subjects met inclusion criteria. The TXA cohort experienced 11.5% less time under hypotensive anesthesia when compared to the group that did not receive TXA. Additionally, surgical length was decreased by more than 28 min when subjects received TXA. No subjects required a blood transfusion or experienced any TXA-related complications. Given the recommendations to limit hypotensive anesthesia perioperatively, TXA is a useful adjunct in orthognathic surgery to limit controlled hypotensive anesthesia.

Ockerman A, Vanassche T, Garip M et al (2021) Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review. Thromb J 19(1):54. https://doi.org/10.1186/s12959-021-00303-9CrossRefPubMedPubMedCentral

Zellin G, Rasmusson L, Pålsson J, Kahnberg KE (2004) Evaluation of hemorrhage depressors on blood loss during orthognathic surgery: a retrospective study. J Oral Maxillofac Surg 62(6):662–666. https://doi.org/10.1016/j.joms.2004.02.001CrossRefPubMed

Jozefowicz E, Sabourdin N, Lambelin V, Lejeune V, Delassus R, Tavernier B (2022) The effect of tranexamic acid on blood loss in orthognathic surgery: a randomized, placebo-controlled, equivalence study. Int J Oral Maxillofac Surg 51(5):637–642. https://doi.org/10.1016/j.ijom.2021.08.018CrossRefPubMed

Challari S, Ranganath K, Patil S, Prasad K, Sejal KM, Sagar P (2019) Efficacy of tranexamic acid with hypotensive anesthesia versus hypotensive anesthesia alone on intraoperative blood loss in orthognathic surgeries-a comparative study. J Dent Orofac Res 15(2):21–30

Sharma H, Arora S, Bhatia N, Rattan V, Sethi S (2020) Tranexamic acid is associated with improved operative field in orthognathic surgery. J Oral Maxillofac Surg 78(9):1509–1517. https://doi.org/10.1016/j.joms.2020.04.037CrossRefPubMed

Choi WS, Irwin MG, Samman N (2009) The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg 67(1):125–133. https://doi.org/10.1016/j.joms.2008.08.015CrossRefPubMed

Sun L, Guo R, Feng Y (2020) Efficacy and safety of tranexamic acid in bimaxillary orthognathic surgery. Plast Surg (Oakv) 28(2):94–104. https://doi.org/10.1177/2292550320925897CrossRefPubMed

Mei A, Qiu L (2019) The efficacy of tranexamic acid for orthognathic surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 48(10):1323–1328. https://doi.org/10.1016/j.ijom.2018.07.027CrossRefPubMed

Siotou K, Siotos C, Azizi A et al (2019) The role of antifibrinolytics in reducing blood loss during craniofacial or orthognathic surgical procedures: a meta-analysis. J Oral Maxillofac Surg 77(6):1245–1260. https://doi.org/10.1016/j.joms.2019.01.032CrossRefPubMed

10.

Song G, Yang P, Hu J, Zhu S, Li Y, Wang Q (2013) The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol 115(5):595–600. https://doi.org/10.1016/j.oooo.2012.09.085CrossRefPubMed

11.

Secher JJ, Sidelmann JJ, Ingerslev J, Thorn JJ, Pinholt EM (2018) The effect of tranexamic acid and gender on intraoperative bleeding in orthognathic surgery-a randomized controlled trial. J Oral Maxillofac Surg 76(6):1327–1333. https://doi.org/10.1016/j.joms.2017.11.015CrossRefPubMed

12.

Rohrich RJ, Cho M-J (2018) The role of tranexamic acid in plastic surgery: review and technical considerations. Plast Reconstr Surg 141(2):507–515. https://doi.org/10.1097/PRS.0000000000003926CrossRefPubMed

13.

Murphy GRF, Glass GE, Jain A (2016) The efficacy and safety of tranexamic acid in Cranio-maxillofacial and plastic surgery. J Craniofac Surg 27(2):374–379. https://doi.org/10.1097/SCS.0000000000002250CrossRefPubMed

14.

Olsen JJ, Skov J, Ingerslev J, Thorn JJ, Pinholt EM (2016) Prevention of bleeding in orthognathic surgery–a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofac Surg 74(1):139–150. https://doi.org/10.1016/j.joms.2015.05.031CrossRefPubMed

15.

Zhao H, Liu S, Wu Z, Zhao H, Ma C (2019) Comprehensive assessment of tranexamic acid during orthognathic surgery: a systematic review and meta-analysis of randomized, controlled trials. J Craniomaxillofac Surg 47(4):592–601. https://doi.org/10.1016/j.jcms.2019.01.021CrossRefPubMed

16.

Eftekharian H, Vahedi R, Karagah T, Tabrizi R (2015) Effect of tranexamic acid irrigation on perioperative blood loss during orthognathic surgery: a double-blind, randomized controlled clinical trial. J Oral Maxillofac Surg 73(1):129–133. https://doi.org/10.1016/j.joms.2014.07.033CrossRefPubMed

17.

Saugel B, Sessler DI (2021) Perioperative blood pressure management. Anesthesiology 134(2):250–261. https://doi.org/10.1097/ALN.0000000000003610CrossRefPubMed

18.

Mazzeffi M, Chow JH, Anders M et al (2021) Intraoperative hypotension and perioperative acute ischemic stroke in patients having major elective non-cardiovascular non-neurological surgery. J Anesth 35(2):246–253. https://doi.org/10.1007/s00540-021-02901-3CrossRefPubMed

19.

Nakatani H, Naito Y, Ida M, Sato M, Okamoto N, Nishiwada T, Kawaguchi M (2021) Association between intraoperative hypotension and postoperative nausea and vomiting: a retrospective analysis of 247 thyroidectomy cases. Braz J Anesthesiol. https://doi.org/10.1016/j.bjane.2021.02.029CrossRefPubMedPubMedCentral

20.

Sessler DI, Bloomstone JA, Aronson S et al (2019) Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth 122(5):563–574CrossRefPubMed

21.

Tegegne SS, Gebregzi AH, Arefayne NR (2021) Deliberate hypotension as a mechanism to decrease intraoperative surgical site blood loss in resource limited setting: a systematic review and guideline. Int J Surg Open 29:55–65. https://doi.org/10.1016/j.ijso.2020.11.019CrossRef

22.

Park SH, Do SH, Kim CS et al (2010) Controlling deliberate hypotension in hypertensive patients undergoing spinal surgery: a comparison between remifentanil and sodium nitroprusside. Anesthes Pain Med 5(1):38–44

23.

Stratton M, Waite PD, Powell KK, Scopel MM, Kukreja P (2022) Benefits of the enhanced recovery after surgery pathway for orthognathic surgery. Int J Oral Maxillofac Surg 51(2):214–218. https://doi.org/10.1016/j.ijom.2021.04.008CrossRefPubMed

24.

Sankar D, Krishnan R, Veerabahu M, Vikraman B (2012) Evaluation of the efficacy of tranexamic acid on blood loss in orthognathic surgery. A prospective, randomized clinical study. Int J Oral Surg 41(6):713–717. https://doi.org/10.1016/j.ijom.2012.01.008CrossRef

Title: Does Tranexamic Acid Reduce the Need for Hypotensive Anesthesia Within Orthognathic Surgery? A Retrospective Study
Authors: Chad W. Dammling
Timothy M. Weber Jr.
Kenneth J. Taylor
Brian E. Kinard
Publication date: 25-02-2024
Publisher: Springer India
Keyword: Tranexamic Acid
Published in: Journal of Maxillofacial and Oral Surgery / Issue 2/2024
Print ISSN: 0972-8279
Electronic ISSN: 0974-942X
DOI: https://doi.org/10.1007/s12663-024-02119-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does Tranexamic Acid Reduce the Need for Hypotensive Anesthesia Within Orthognathic Surgery? A Retrospective Study

Abstract

Background

Aims

Methods

Results and conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aims

Methods

Results and conclusion

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