Propofol Versus Remifentanil: Which One Is More Effective in Reducing Blood Loss During Orthognathic Surgery? A Randomized Clinical Trial.

PURPOSE: Propofol and remifentanil are 2 useful drugs used in induced hypotensive anesthesia. The purpose of this study was to compare the effects of these drugs on intraoperative blood loss, transfusion requirements, and hemodynamic status during standardized orthognathic surgical procedures. MATERIALS AND METHODS: In this double-blind randomized clinical trial, 50 consecutive healthy patients with Class III skeletal deformity were candidates for bimaxillary orthognathic surgery at Qaem Hospital, Mashhad University of Medical Sciences (Mashhad, Iran), from November 2016 until December 2017. These patients were randomly assigned to 2 equal-number groups to receive hypotensive anesthesia with propofol or remifentanil. Neither the surgeon nor the patients were aware of the study groups, whereas both the student and anesthesiologist were not blinded. Age and gender were recorded, and mean blood loss, mean arterial pressure, and mean heart rate, as well as duration of surgery and duration of general anesthesia, were monitored intraoperatively. The hypotensive anesthetic drugs were the primary predictor variables and the mean blood loss volume was the main outcome in this research. The independent t test and chi(2) test were performed for data analysis using SPSS software (version 16; SPSS, Chicago, IL). RESULTS: In this study, 25 patients with a mean age of 22.25 +/- 3.31 years were investigated in each group. The mean blood loss volume was 578.26 +/- 95.14 mL and 366.67 +/- 64.92 mL in the propofol and remifentanil groups, respectively. The independent-samples t test showed that mean blood loss was significantly lower in the remifentanil group than in the propofol group (P = .001). Furthermore, the mean arterial blood pressure was significantly lower in the remifentanil group than in the propofol group (85 +/- 20 mm Hg vs 95 +/- 15 mm Hg, P < .001). CONCLUSIONS: Hypotensive anesthesia with remifentanil, in comparison with propofol, significantly reduces mean blood loss during orthognathic surgery, which decreases the transfusion requirements and disadvantages of transfusion and blood loss.