Sharma Harjinder, Arora Suman, Bhatia Nidhi, Rattan Vidya, Sethi Sameer
Junior Resident, Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Professor, Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Oral Maxillofac Surg. 2020 Sep;78(9):1509-1517. doi: 10.1016/j.joms.2020.04.037. Epub 2020 May 4.
In the past, both tranexamic acid and dexmedetomidine have been used separately to decrease intraoperative blood loss during orthognathic surgery. However, their combined use in the same setting has never been prospectively evaluated. The present study was conducted to evaluate the effect of tranexamic acid on operative field visibility and blood loss during orthognathic surgery after dexmedetomidine-induced hypotensive anesthesia.
The present prospective, randomized clinical trial included patients who had undergone orthognathic surgery under general anesthesia. The patients were divided into 2 groups. The dexmedetomidine and tranexamic (DT) group received an intravenous bolus of tranexamic acid (15 mg/kg) and intravenous dexmedetomidine (0.25 to 0.7 μg/kg/hr) as maintenance infusion. The dexmedetomidine (DS) group received only intravenous dexmedetomidine at the same dosage. All the patients received a bolus dose of intravenous dexmedetomidine (1 μg/kg) before the start of anesthesia induction. The operating surgeon rated the quality of the surgical visual field every 15 minutes using the Fromme ordinal scale. Intraoperative blood loss was estimated using the modified gross formula. The operating surgeon's satisfaction was assessed using a Likert scale. Data were analyzed using SPSS, version 22.0 (IBM Corp, Armonk, NY). Kolmogorov-Smirnov tests were used to assess the normality of the measured data, and categorical variables were analyzed using the χ or Fischer exact test.
The study sample included 36 patients, with a mean age of 23.67 ± 11.298 years in the DS group and 20.28 ± 3.286 years in the DT group. Of the patients in the DS and DT groups, 66.66 and 61.11% were male, respectively. No statistically significant differences were found in the baseline characteristics between the 2 treatment groups. The surgeon reported a significantly better surgical visual field in the DT group compared with that in the DS group (P = .001). Also, the intraoperative blood loss significantly less in the DT group (231.11 ± 137.64 mL vs 360.17 ± 187.86 mL; P = .025).
Tranexamic acid improved surgical field visibility and reduced intraoperative blood loss when administered in conjunction with dexmedetomidine during orthognathic surgery under controlled hypotensive anesthesia.
过去，氨甲环酸和右美托咪定已分别用于减少正颌手术中的术中失血。然而，它们在同一情况下的联合使用从未进行过前瞻性评估。本研究旨在评估在右美托咪定诱导的低血压麻醉下，氨甲环酸对正颌手术中手术视野清晰度和失血的影响。
本前瞻性随机临床试验纳入了在全身麻醉下接受正颌手术的患者。患者分为两组。右美托咪定与氨甲环酸（DT）组静脉推注氨甲环酸（15mg/kg）并静脉输注右美托咪定（0.25至0.7μg/kg/小时）作为维持输注。右美托咪定（DS）组仅接受相同剂量的静脉右美托咪定。所有患者在麻醉诱导开始前接受静脉推注右美托咪定（1μg/kg）。手术医生每15分钟使用弗罗梅序数量表对手术视野质量进行评分。术中失血采用改良的总量公式估算。使用李克特量表评估手术医生的满意度。数据使用SPSS 22.0版（IBM公司，纽约州阿蒙克）进行分析。使用柯尔莫哥洛夫-斯米尔诺夫检验评估测量数据的正态性，分类变量使用χ²检验或费舍尔精确检验进行分析。
研究样本包括36例患者，DS组平均年龄为23.67±11.298岁，DT组平均年龄为20.28±3.286岁。DS组和DT组患者中，男性分别占66.66%和61.11%。两个治疗组的基线特征未发现统计学显著差异。与DS组相比，手术医生报告DT组的手术视野明显更好（P = 0.001）。此外，DT组的术中失血量明显更少（231.11±137.64mL对360.17±187.86mL；P = 0.025）。
在控制性低血压麻醉下的正颌手术中，氨甲环酸与右美托咪定联合使用时可改善手术视野清晰度并减少术中失血。
