Is Tranexamic Acid Associated With a Reduced Need for Hypotensive Anesthesia During Orthognathic Surgery?

Background: No prior study in orthognathic surgery has isolated the effects of tranexamic acid (TXA) from deliberate hypotensive anesthesia (HA). Due to hypoperfusion risks with HA, it is valuable to evaluate the efficacy of TXA in the absence of HA as the utility of TXA to decrease blood loss may potentially make HA an unnecessary risk.

Purpose: The study purpose was to assess surgical site visualization and measure blood loss among subjects exposed to TXA during bimaxillary orthognathic surgery without deliberate HA.

Study design, setting, sample: A prospective cohort study was performed at the University of Alabama at Birmingham for subjects ages 14 to 75 who received TXA during bimaxillary orthognathic surgery. Exclusion criteria included those who underwent single jaw surgery or could not receive TXA.

Predictor variable: The predictor variable was the percentage of time spent under HA; either greater or less than 10%.

Main outcome variables: The main outcome variable was blood loss measured by surgical field visibility, estimated blood loss, and changes in hemoglobin and hematocrit.

Covariates: Covariates included age, sex, race, American Society of Anesthesiologists physical status classification score, surgery length, osteotomy type, and concomitant procedures.

Analyses: Bivariate analyses were used to measure the association between level of HA and blood loss. P value of < 0.05 was considered statistically significant.

Results: The sample was composed of 115 subjects with a mean age of 26.1 ± 11.4 and 69 (60.0%) were female. There were 51 (44.3%) subjects with less than 10% of the case under HA versus 64 (55.7%) with greater than 10% HA. There was no statistically significant difference between the cohorts in terms of surgical field visibility, estimated blood loss, or changes in hemoglobin or hematocrit (P values > 0.1).

Conclusions and relevance: TXA use maintains surgical visibility and blood loss under normotensive conditions that is not inferior to HA. Usage of normotensive anesthesia may decrease costs secondary to medication usage, usage of invasive monitoring, and contributes to efficiency of surgical care. These findings may decrease reliance on HA and its inherent risk of end organ damage; a randomized controlled trial is necessary to confirm these findings.