Tranexamic Acid Is Associated With Improved Operative Field In Orthognathic Surgeries

Abstract Purpose In the past, both tranexamic acid and dexmedetomidine have been used separately for decreasing intraoperative blood loss in orthognathic surgeries; however, their combined use in the same setting has never been prospectively evaluated. The study was conducted to evaluate the effect of tranexamic acid on operative field visibility and blood loss in orthognathic surgeries under dexmedetomidine induced hypotensive anesthesia. Methods This prospective, randomized clinical trial was conducted in patients undergoing orthognathic surgery under general anesthesia. Patients were divided into two groups, wherein patients belonging to group DT received intravenous bolus of tranexamic acid 15mg/kg alongwith intravenous dexmedetomidine 0.25-0.7μg/kg/hr as a maintenance infusion. Patients in group DS received only intravenous dexmedetomidine 0.25-0.7μg/kg/hr. All patients received a bolus dose of intravenous dexmedetomidine 1μg/kg prior to start of anesthesia induction. The operating surgeon rated the quality of surgical visual field every 15 minutes using Fromme’s ordinal scale. Intraoperative blood loss was estimated by the modified gross formula and operating surgeon’s satisfaction was assessed by Likert scale. Data was analysed using SPSS version 22.0. Kolmogorov-Smirnov tests were applied to asssess the normality of measured data and categorical variables using Chi-square test or Fischer’s exact tests. Results Study sample was composed of 36 subjects with a mean age of 23.67±11.298 years in group DS and 20.28±3.286 years in group DT. 66.66 and 61.11% of patients were males in group DS and DT, respectively. There were no statistically significant differences in the sample's baseline characteristics between the two treatment groups. The surgeon reported a significantly better surgical visual field in group DT as compared to group DS (p=0.001), with the intraoperative blood loss also being significantly less in patients belonging to group DT (231.11±137.64mL vs 360.17±187.86mL; p=0.025). Conclusion Tranexamic acid improved the quality of surgical field visibility and reduced intraoperative blood loss when administered along with dexmedetomidine in orthognathic surgeries under controlled hypotensive anesthesia.