Hypotensive anesthesia in maxillofacial surgeries: Current concepts

Hypotensive anesthesia is a commonly used technique that aims to reduce intraoperative blood loss, consequently improving surgical field visibility and the need for blood transfusions post-operatively. It is widely used in major maxillofacial surgeries with a high risk of intraoperative bleeding. The aim is to reduce the patient’s systolic blood pressure to 80 to 90 mm Hg and mean arterial pressure (MAP) by at least 30% of preoperative blood pressure or keeping a minimum MAP of 50–65 mmHg. Hypotensive anesthesia not only provides a bloodless surgical field but also helps to identify various anatomical structures. There are various pharmacological and non-pharmacological methods to induce hypotensive anesthesia. The decision to induce hypotensive anesthesia should be based according to the general condition of the patient, the extent of the surgery, and in coordination with the operating surgeon. The target blood pressure should be adjusted according to the patient’s preoperative status and coexisting illness. The risk of organ hypoperfusion should be kept in mind. Close intraoperative monitoring with optimal patient selection is important for good patient outcomes.