[26] evaluated 127 questionnaires about autologous
donation of blood in patients who underwent
orthognathic surgery; 65 patients (51%) reported
that autologous blood donation was decisive for the
agreement to operate and that 12 patients (9%) would
have refused the operation without the possibility of
autologous blood donation.
It should be recommended that the decision to offer the
possibility of preoperative autologous blood donation
should not be done as a gain-framed or loss-framed
persuasive message. A loss-framed persuasive appeal
emphasises the disadvantages of failing to comply with
the communicator’s recommendation; in contrast, the
gain-framed appeal will emphasise the advantages of
compliance. Both are well-known techniques in patient
communication [67]. Obviously, legal recommendations
[66] and court rules in Germany [22] and in the United
States [24] do not facilitate the information task towards
the patient [26], because the patients need to be
informed about the risks of homologous transfusion
and the possibility of autologous blood transfusion as
an alternative. Blau et al [49] reported that based on the
perceived safety of reinfusion of autologous blood, the
transfusion decision was made even before knowledge
of the postoperative hemoglobin level.
5. Discussion and Conclusions
Considering the risk factors for blood transfusion after
orthognathic surgery, a great deal of attention has
been focused in the past both on the relationship with
the duration of the surgery and the blood loss during
surgery and in the postoperative period. Blood loss
and duration of surgery are only weakly related to each
other. The most significant factor in deciding when to
transfuse is one’s attitude towards transfusion and the
related ‘trigger’ criterion for transfusion. Although the
contemporary limit of 7 g/dL is a safe margin for healthy
persons, the measurable increase in cardiac output
needs to be observed.
It is important to know that Hb drop could be
overestimated due to hemodilution, which in return
may influence the decision of blood transfusion [68]. The
estimated blood loss might be a good guide, especially in
cases that received large amounts of i.v. fluids. According
to Al-Sebaei et al [69], blood loss does not consistently
increase over time. The majority of intra-operative blood
loss is expected to occur in the beginning of the procedure
during the performance of the osteotomies [69].
On the other hand, it has been shown that predonation
of autologous blood both increases the necessity and
the opportunity to use it. Nevertheless, any blood
transfusion is graded as a grade II complication in the
Clavien-Dindo complication classification system.
Minimising perioperative blood loss seems to be a
multidisciplinary task in which both the anesthesiologist
and the surgeon share a common responsibility. The
timely adaptation of legal guidelines to adopting
a nontransfusion default position when there is no
evidence for potential benefit is the wise approach.
and prepared the protocol. CP, JOA and IL were involved
in the analysis of data and the writing of the manuscript.
All authors read and approved the final manuscript.
Acknowledgment
Not applicable. The study was self-funded. There are
no conflicts of interest and no financial interests to be
disclosed.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Author contributions
CP was the principle investigator who initiated, designed
Stomatology Edu Journal
16.
Posnick JC, Rabinovich A, Richardson DT. Blood replacement
practices for complex orthognathic surgery: a single surgeon's
experience. J Oral Maxillofac Surg. 2010;68(1):54-59. doi: 10.1016/j.
joms.2009.07.055.
[Full text links] [PubMed] Google Scholar(11) Scopus(6)
Holty JE, Guilleminault C. Maxillomandibular advancement for
the treatment of obstructive sleep apnea: a systematic review and
meta-analysis. Sleep Med Rev. 2010;14(5):287-297. doi: 10.1016/j.
smrv.2009.11.003.
[Full text links] [PubMed] Google Scholar(264) Scopus(147)
Perisanidis C, Herberger B, Papadogeorgakis N, et al.
Complications after free flap surgery: do we need a standardized
classification of surgical complications? Br J Oral Maxillofac Surg.
2012;50(2):113-118. doi: 10.1016/j.bjoms.2011.01.013.
[Full text links] [PubMed] Google Scholar(31) Scopus(18)
Carson JL, Carless PA, Hebert PC. Transfusion thresholds
and other strategies for guiding allogeneic red blood cell
transfusion. Cochrane Database Syst Rev. 2012;(4):CD002042. doi:
10.1002/14651858.CD002042.pub3.
[Full text links] [Free PMC Article] [PubMed] Google Scholar(554)
Scopus(352)
Iwase Y, Kohjitani A, Tohya A, et al. Preoperative autologous
blood donation and acute normovolemic hemodilution
affect intraoperative blood loss during sagittal split ramus
osteotomy. Transfus Apher Sci. 2012;46(3):245-251. doi: 10.1016/j.
transci.2012.03.014.
[Full text links] [PubMed] Google Scholar(7) Scopus(2)
Bottger S. Untersuchungen zum Transfusionsbedarf
bei kieferorthopädisch-chirurgischen Eingriffen unter
Berücksichtigung individueller Patientenparameter. Dissertation.
Giessen: Justus Liebig Universität Giessen; 2007.
Google Scholar (1)
Lassacher MD. Management of blood loss in selective oral
and maxillofacial surgery (in German). Doctoral Thesis. Gratz:
University of Graz; 2008.
Enlund MG, Ahlstedt BL, Andersson LG, et al. Induced
hypotension may influence blood loss in orthognathic surgery,
but it is not crucial. Scand J Plast Reconstr Surg Hand Surg.
1997;31(4):311-317.
Google Scholar(32) Scopus(23)
Ash DC, Mercuri LG. The relationship between blood ordered
and blood administered in orthognathic surgery: a retrospective
study. J Oral Maxillofac Surg. 1985;43(12):944-946.
[Full text links] [PubMed] Google Scholar(23) Scopus(18)
Borstlap WA, Stoelinga PJ, Hoppenreijs TJ, et al. Stabilisation
of sagittal split advancement osteotomies with miniplates: a
prospective, multicentre study with two-year follow-up. Part I.
Clinical parameters. Int J Oral Maxillofac Surg. 2004;33(5):433-441.
doi: 10.1016/j.ijom.2004.02.003.
[Full text links] [PubMed] Google Scholar(192) Scopus(44)
Carry PY, Dubost J, Roche C, et al. [Perioperative medical
complications in orthognathic surgery]. Rev Stomatol Chir
Maxillofac. 2001;102(1):7-11.
[PubMed] Google Scholar(3) Scopus(3)
Dhariwal DK, Gibbons AJ, Kittur MA, et al. Blood transfusion
requirements in bimaxillary osteotomies. Br J Oral Maxillofac Surg.
2004;42(3):231-235. doi: 10.1016/j.bjoms.2003.11.001.
[Full text links] [PubMed] Google Scholar(45) Scopus(31)
Fenner M, Kessler P, Holst S, et al. Blood transfusion in bimaxillary
orthognathic operations: need for testing of type and screen.
Br J Oral Maxillofac Surg. 2009;47(8):612-615. doi: 10.1016/j.
bjoms.2009.01.023.
[Full text links] [PubMed] Google Scholar(12) Scopus(8)
Garg M, Cascarini L, Coombes DM, et al. Multicentre study of
operating time and inpatient stay for orthognathic surgery.
Br J Oral Maxillofac Surg. 2010;48(5):360-363. doi: 10.1016/j.
bjoms.2009.08.035.
[Full text links] [PubMed] Google Scholar(32) Scopus(22)
Golia JK, Woo R, Farole A, et al. Nitroglycerin-controlled circulation in
orthognathic surgery. J Oral Maxillofac Surg. 1985;43(5):342-345.
[Full text links] [PubMed] Google Scholar(17) Scopus(12)
Gong SG, Krishnan V, Waack D. Blood transfusions in bimaxillary
orthognathic surgery: are they necessary? Int J Adult Orthodon
BLOODLOSS AND TRANSFUSION NEED IN ORTHOGNATHIC SURGERY:
REVIEW OF LITERATURE
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