Preventive use of landiolol beneficial for patients undergoing bimaxillary surgery, suggests study

The difficulty in bimaxillary surgery is the considerable bleeding during the surgery, leading to the exploration of different methods to reduce blood loss. Recent study aimed to assess the risks and benefits of using hypotensive anesthesia and piezosurgical instruments in bimaxillary surgery, particularly regarding their impact on intraoperative bleeding and cardiac function. The research found that the combined use of hypotensive anesthesia and piezosurgical instruments significantly reduced intraoperative bleeding, but was associated with a higher incidence of tachycardia, especially when using nicardipine. The combination also significantly lengthened the duration of the surgery and may have increased the burden on cardiac function. The study suggested that proactive preparation and preventive small-dose administration of landiolol could be beneficial in managing the potential occurrence of tachycardia when employing hypotensive anesthesia.

Reducing Blood Loss in Bimaxillary Surgery

Bimaxillary surgery, which combines mandibular and maxillary osteotomies, involves significant intraoperative bleeding and the need for transfusion, making it crucial to explore alternative measures with minimal adverse effects to reduce blood loss. Hypotensive anesthesia, a technique in which blood pressure is intentionally lowered during surgery to reduce bleeding, has been recognized for its potential in reducing intraoperative bleeding, but concerns regarding vital organ hypoperfusion during hypotensive anesthesia have been raised in other studies. The use of piezosurgical instruments in bimaxillary surgery provides an alternative strategy for bleeding management, albeit with potential challenges such as prolonged surgical duration. The study collected and analyzed data from the medical records of 30 patients who underwent bimaxillary surgery between 2015 and 2023. The results indicated that the combination of hypotensive anesthesia and piezosurgical instruments effectively reduced blood loss. However, it was observed that tachycardia may occur during hypotensive anesthesia, especially when nicardipine is used, which may lead to a strain on cardiac function. The study demonstrated the effectiveness of landiolol in managing tachycardia and suggested that the preparation and preventive use of landiolol may be beneficial for patients undergoing bimaxillary surgery.

Challenges and Limitations of Combined Approach

The study also highlighted the challenges and limitations involved in the combined use of hypotensive anesthesia and piezosurgical instruments, including the inability to discern the individual impacts of each method and the potential confounding variables associated with variations in anesthesia methods and hypotensive techniques. Additionally, the study indicated the need for further research and larger scale studies in this area to better understand the risks and benefits of the combined approach in bimaxillary surgery.

Key Points

- The study assessed the risks and benefits of using hypotensive anesthesia and piezosurgical instruments in bimaxillary surgery, aiming to reduce intraoperative bleeding and strain on cardiac function. - The combined use of hypotensive anesthesia and piezosurgical instruments was found to significantly reduce intraoperative bleeding, but it was associated with a higher incidence of tachycardia, particularly when using nicardipine. The combination also led to a significant lengthening of the surgical duration and potential increased burden on cardiac function.

- The study suggested that proactive preparation and preventive small-dose administration of landiolol could be beneficial in managing the potential occurrence of tachycardia when employing hypotensive anesthesia.

- Bimaxillary surgery involves significant intraoperative bleeding and the need for transfusion, making it crucial to explore alternative measures with minimal adverse effects to reduce blood loss. The combination of hypotensive anesthesia and piezosurgical instruments effectively reduced blood loss, but concerns regarding tachycardia during hypotensive anesthesia, especially when nicardipine is used, highlight the need for careful management of cardiac function.

- The study demonstrated the effectiveness of landiolol in managing tachycardia and suggested that proactive preparation and preventive use of landiolol may be beneficial for patients undergoing bimaxillary surgery.

- The study also highlighted the challenges and limitations involved in the combined use of hypotensive anesthesia and piezosurgical instruments, including the inability to discern the individual impacts of each method and the need for further research and larger scale studies in this area to better understand the risks and benefits of the combined approach in bimaxillary surgery.

Reference -

Yamamura K, Murakami K, Hirata Y, et al. (August 21, 2024) Assessing the Risks and Benefits of Hypotensive Anesthesia and Piezosurgical Instruments in Bimaxillary Surgery. Cureus 16(8): e67394. DOI 10.7759/cureus.67394