Hypotensive Anesthesia

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Induced hypotensive anesthesia:
Deliberate hypotensive anesthesia was first introduced to clinical practice by Gardner in 1946 who used arteriotomy to reduce arterial blood pressure during removal of a vascular lesion from the base of the skull (Gardner, 1946). Schaberg et al. (1976) was the first surgeon who used this technique in oral and maxillofacial surgery. Controlled hypotension is commonly used technique to limit blood loss during specific surgical procedures on specific areas in which surgical hemostasis may be difficult (hip, spine, and facial bones) (Tobias, 1996), but Samman (2008) concluded that this technique remains controversial in oral and maxillofacial surgery after a systemic review regarding benefits and risks of deliberate hypotension in anesthesia. The technique
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2004). Several different pharmacologic agents have been used for controlled hypotension, including inhalational anesthetic agents, beta-adrenergic antagonists, calcium channel blockers, and vasodilators such as nitroglycerin and sodium nitroprusside (Rodrigo, 1995). As reported by Schaberg et al. (1976) hypotensive anesthesia decrease the reduction of blood loss volume by 44%. Dolman et al. (2000) compared hypotensive and normotensive anesthesia in mean blood loss in orthognathic surgery patients and he found that mean blood loss in patients operated under normotensive anesthesia was 270.2 ml while patients treated under hypotensive anesthesia was 120.3 ml. Praveen et al. (2001) mentioned that mean blood loss in patient operated in hypotension was 200 ml and patient under normotension was 350 ml with 44% reduction in blood loss. A systemic review done by Choi and Samman (2008) and they concluded that hypotensive anesthesia is effective in blood loss and can be justified to be used as a routine procedure for orthognathic surgery especially bimaxillary osteotomy. Ervens et al. (2010) found that average blood loss in normotensive group was 1021 ml
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