Effects of Total Intravenous Anesthesia vs. Balanced Inhalation Anesthesia on Hemodynamics and Recovery in Orthognathic Surgery

Fredrik Widar1,3*, Josephine Skoldstam1 , Jan Creutz2 , Hossein Kashani3 and Christer Dahlin1,4

1 Department of ENT and Oral Maxillofacial Surgery, NU Hospital Group, Sweden 2 Department of Anesthesiology, NU Hospital Group, Trollhattan, Sweden 3 Department of Oral and Maxillofacial Surgery, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Sweden 4 Department of Biomaterials & BIOMATCELL VINN Excellence Centre, Institute for Surgical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden

^*Correspondance to: Fredrik Widar 

 PDF  Full Text DOI: 10.25107/2474-1647.3176

Abstract

Purpose: The main objective of the present study was to evaluate haemodynamics and recovery parameters in relation to two anesthetic techniques; remifentanil-propofol based Total Intravenous Anesthesia (TIVA), vs. Fentanyl-sevoflurane based balanced inhalation anesthesia (BA) in orthognathic surgery. The second objective was to evaluate long duration local anesthesia administered after surgery on recovery parameters. Subjects and Methods: Medical records were retrospectively reviewed from 269 patients who had undergone orthognathic surgery between 2003 and 2013. Ninety-four patients were audited due to strict inclusion criteria in order to compare the two anesthetic techniques. Haemodynamics were evaluated with parameters such as blood loss, Mean Arterial Pressure (MAP), values of systole and diastole, and heart rate. Recovery was investigated with parameters such as Postoperative Nausea and Vomiting (PONV), recovery time at the Postanesthesia Unit (PACU), pain and hospitalization. Furthermore, we analyzed possible influences of age, gender, Body Mass Index (BMI) and operating time. Results: No significant differences regarding blood loss, operating time, recovery time, PONV and hospitalization were found between the two anesthetic techniques. There was a significant continuously improvement regarding reduced blood loss, operating time and (hospitalization) during the 10-year follow-up in all patients. TIVA facilitated hemodynamic stability through superior pain/stress control during surgery. The addition of long duration anesthesia (ropivacaine 7.5 mg/ml) given at the end of surgery significantly reduced hospitalization (p=0.0028) when analyzed separately. Conclusions: No significant differences between the two anesthetic techniques regarding blood loss, operating time, recovery time, PONV and hospitalization were found. TIVA facilitated hemodynamic stability. Long duration local anesthetics given at the end of surgery appears to improve mobilization of the patient and reduce hospitalization.

Keywords

Orthognathic surgery; Anesthesia; Hemodynamic; Remifentanil; Propofol; Fentanyl; Ropivacaine

Cite the article

Widar F, Skoldstam J, Creutz J, Kashani H, Dahlin C. Effects of Total Intravenous Anesthesia vs. Balanced Inhalation Anesthesia on Hemodynamics and Recovery in Orthognathic Surgery. Clin Surg. 2021; 6: 3176..