What are Perioperative adverse cardiac events in maxillofacial surgery?

Recently published meta-analysis focused on the incidence and presentation of perioperative adverse cardiac events (ACEs) during maxillofacial surgery in adults. The review included 12 studies with a total of 34,227 patients and categorized ACEs into four types. The main findings include an overall incidence of ACEs of 2.58%, with heart rate and rhythm disturbances resulting in the greatest incidence among the four categories. Most commonly, ACEs resulted in intensive care unit (ICU) admission, impacting surgical outcomes. The review also revealed that ACEs, particularly heart rate and rhythm disturbances, can disproportionately impact surgical outcomes. Additionally, the analysis identified a potential publication bias, the impact of anaesthetic agents on the development of ACEs, and the occurrence of trigeminocardiac reflex (TCR) during maxillofacial surgeries.

Impact of Perioperative Adverse Cardiac Events (ACEs) on Surgical Outcomes

The findings suggest that perioperative ACEs, while relatively rare, can have a significant impact on surgical outcomes, necessitating ICU admission in a substantial proportion of cases. The review also highlighted the potential role of anaesthetic agents in contributing to ACEs and the importance of understanding the TCR in intraoperative bradycardia. The analysis had limitations, including potential publication bias, variations in the reporting and categorization of ACEs across studies, and geographic bias. The conclusions of this review emphasize the need for large-scale prospective studies to better understand the contributory factors and long-term effects of ACEs in patients during maxillofacial surgery. This study serves as valuable groundwork for future research in this area, providing insights into potential areas of interest, such as contributory factors and long-term implications, for future researchers.

Key Points

- A systematic review and meta-analysis of 12 studies with 34,227 patients focused on the incidence and presentation of perioperative adverse cardiac events (ACEs) during maxillofacial surgery in adults. The overall incidence of ACEs was found to be 2.58%, with heart rate and rhythm disturbances having the greatest incidence among the four categories of ACEs.

- Perioperative ACEs were found to have a significant impact on surgical outcomes, often resulting in the need for intensive care unit (ICU) admission. The review emphasized the potential role of anaesthetic agents in contributing to ACEs and the importance of understanding the trigeminocardiac reflex (TCR) in intraoperative bradycardia.

- The study identified limitations such as potential publication bias, variations in the reporting and categorization of ACEs across studies, and geographic bias. The conclusion highlighted the need for large-scale prospective studies to better understand the contributory factors and long-term effects of ACEs in patients during maxillofacial surgery, underscoring the study's valuable groundwork for future research.

Reference –

Chohan, Mehak*; Liu, Winnie1,*; Chowdhury, Tumul2. Perioperative adverse cardiac events in maxillofacial surgery: A systematic review and meta-analysis. Indian Journal of Anaesthesia 68(5):p 426-438, May 2024. | DOI: 10.4103/ija.ija_1206_23