The evidence in this summary applies to individuals older than 14 years who were treated by orthognathic surgery.

All the selected outcomes are considered critical for decision making according to the opinion of the authors of this summary, which coincide in general with those evaluated by the systematic reviews.

The outcome mortality was included in the summary of findings table because it is a relevant outcome for clinical experts, even though it is not a frequent outcome, and was not reported by the reviews either. This also applies to the outcome of adverse effects, which was included because it reports relevant information regarding complications or post-operative aspects associated with orthognathic surgery. However, they were not reported in the reviews.

The evidence included for this summary shows a slight benefit in the use of hypotensive anesthesia compared to normotensive anesthesia, in orthognathic surgery.

With the use of hypotensive anesthesia there is little benefit reducing intraoperative blood loss, operation time, and improving the quality of the surgical field

Based on the above, the risk/benefit balance could be in favor towards the use of a hypotensive anesthesia in orthognathic surgery.

None of the trials conducted a cost analysis regarding the use of hypotensive anesthesia. However, there is evidence that the additional costs associated with complications of orthognathic surgery can be considerable.

Currently, there are no economic trials that evaluate the real cost-effectiveness of this treatment, which would be necessary to be able to evaluate this aspect in greater depth.

Given the evidence presented in this summary, most patients and surgeons should prefer hypotensive anesthesia rather than normotensive anesthesia, since with hypotensive anesthesia, there is a likely reduction in the intraoperative blood loss and operation time, and thus in their socio-economic consequences.

Additionally, it is important to emphasize that this is valid as long as there is a correct and precise indication for hypotensive anesthesia.

Controlled hypotension is not universally applicable across all patient cases, necessitating meticulous patient selection in collaboration with the anesthesia team. This approach aims to avert exacerbation of ischemic events in the heart, brain, and kidneys during hypotensive surgical procedures.

The conclusions of this summary are consistent with all of the identified systematic reviews [2], [4], [5], which consider that the use of hypotensive anesthesia probably reduces the intraoperative blood loss, thus reducing the operation time and improving the quality of the surgical field.

On the other hand, none of the included systematic reviews assessed the certainty of the evidence regarding the outcomes.

The probability that future evidence will change the conclusions of this summary is high, due to the uncertainty associated with some critical outcomes for decision making.

Searching the International Clinical Trials Registry Platform of the World Health Organization and the PROSPERO database, we did not identify any ongoing clinical trial or systematic review.