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

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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.

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Funding

No funding was provided for this study.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA

    Chad W. Dammling

  2. Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA

    Timothy M. Weber Jr.

  3. Nursing Acute, Chronic & Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA

    Kenneth J. Taylor

  4. Department of Oral and Maxillofacial Surgery, Department of Orthodontics, University of Alabama at Birmingham School of Dentistry, 1919 7th Ave S, SDB 419, Birmingham, Alabama, 35294-0007, USA

    Brian E. Kinard

Authors
  1. Chad W. Dammling
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  2. Timothy M. Weber Jr.
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  3. Kenneth J. Taylor
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  4. Brian E. Kinard
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Contributions

BEK and CWD were involved in concept and design of the study and drafting of the manuscript. KJT and TMW were involved in interpretation and analysis of data and drafting of the manuscript. CWD and TMW were involved in data acquisition. BEK gave the final approval for submission.

Corresponding author

Correspondence to Brian E. Kinard.

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Conflict of interest

All authors declare that they have no conflict of interest with regard to the study design, drafting and subsequent publication of the article and have not received any funding/grant for the data collection, analysis and drafting of the manuscript.

Ethical Approval

IRB approval was granted through the University of Alabama at Birmingham: IRB–30008753.

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Dammling, C.W., Weber, T.M., Taylor, K.J. et al. Does Tranexamic Acid Reduce the Need for Hypotensive Anesthesia Within Orthognathic Surgery? A Retrospective Study. J. Maxillofac. Oral Surg. 23, 229–234 (2024). https://doi.org/10.1007/s12663-024-02119-2

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  • DOI: https://doi.org/10.1007/s12663-024-02119-2

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