Division of Plastic and Reconstructive Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA.
Department of Anesthesiology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
Aesthetic Plast Surg. 2023 Dec;47(6):2632-2638. doi: 10.1007/s00266-023-03298-y. Epub 2023 Mar 6.
BACKGROUND/PURPOSE: Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore, management of blood pressure has been shown to promote greater visualization of the surgical field and decrease postoperative complications, such as ecchymosis and edema. While multiple therapies have been utilized to achieve permissive hypotension, it remains unclear how modalities compare in terms of safety and efficacy. The purpose of this study was to conduct a systematic review to better understand the specific modalities and associated outcomes in managing blood pressure during rhinoplasty.
A systematic literature review was conducted in order to identify and assess therapeutics utilized in achieving permissive hypotension during rhinoplasty. Variables collected included year of publication, journal, article title, organization of study, patient sample, treatment modality, associated outcomes (i.e., intraoperative bleeding, edema, and ecchymosis), adverse events, complications, and satisfaction. Articles were then categorized by the level of evidence as set forth by the American Society of Plastic Surgeons. Any conflicts were resolved through discussion and full-text review among co-authors. Of note, the search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No funding was required to conduct this review of the literature.
Initial review yielded sixty-five articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of ten studies for analysis. Articles discussed multiple therapies for management of blood pressure during rhinoplasty, including dexmedetomidine, dexamethasone, gabapentin, labetalol, nitroglycerine, remifentanil, magnesium sulfate, clonidine, and metoprolol. Overall, intraoperative bleeding, as well as postoperative ecchymosis and edema were reduced when MAP was controlled.
Given its intra- and postoperative benefits, permissive hypotension can be leveraged to improve outcomes in rhinoplasty. This study presents an updated comprehensive review of various modalities used to achieve permission hypotension in rhinoplasty. Future studies should explore how comorbidities may impact choice of treatment regimen among patients undergoing rhinoplasty.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
背景/目的：在进行鼻整形术的外科医生中，允许性低血压（定义为平均动脉压（MAP）为 60-70mmHg）被认为是有利的。此外，血压管理已被证明可以促进手术视野的更好可视化，并减少术后并发症，如瘀斑和水肿。虽然已经使用了多种疗法来实现允许性低血压，但尚不清楚各种方式在安全性和疗效方面的比较情况。本研究的目的是进行系统评价，以更好地了解在鼻整形术中管理血压的具体方式和相关结果。
为了确定和评估在鼻整形术中实现允许性低血压的治疗方法，进行了系统的文献回顾。收集的变量包括出版年份、期刊、文章标题、研究组织、患者样本、治疗方式、相关结果（即术中出血、水肿和瘀斑）、不良事件、并发症和满意度。然后根据美国整形外科学会规定的证据水平对文章进行分类。通过共同作者之间的讨论和全文审查解决任何冲突。值得注意的是，该搜索是根据系统评价和荟萃分析的首选报告项目指南进行的。进行这项文献综述不需要资金。
最初的审查产生了 65 篇文章。通过标题和摘要审查，然后应用标准化的纳入和排除标准，最终有 10 项研究进行了分析。这些文章讨论了多种治疗方法来管理鼻整形术中的血压，包括右美托咪定、地塞米松、加巴喷丁、拉贝洛尔、硝酸甘油、瑞芬太尼、硫酸镁、可乐定和美托洛尔。总体而言，控制平均动脉压可减少术中出血以及术后瘀斑和水肿。
鉴于其围手术期的益处，允许性低血压可用于改善鼻整形术的结果。本研究对各种用于实现鼻整形术允许性低血压的方式进行了最新的综合评价。未来的研究应探讨合并症如何影响接受鼻整形术的患者的治疗方案选择。
证据水平 III：本杂志要求作者为每篇文章分配一个证据水平。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
