Objective To observe the effect of controlled hypotension using nicardipine on postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing orthognathic surgery. Methods A total of 199 patients who underwent orthognathic surgery in our hospital from October 2019 to April 2023 were selected as the study subjects. They were randomly divided into a deepened anesthesia group (group P) with 98 patients and a nicardipine group (group N) with 101 patients. In group P, controlled hypotension was performed by increasing the pump dose of propofol, and in group N, parallel controlled hypotension was performed by compound pump injection of nicardipine, the target was to reduce the MAP to below 65 mmHg. The incidence of SIRS on the first day after operation, mean arterial pressure (MAP), heart rate (HR) at different times during operation, and patient state index (PSI) of anesthesia depth, dosage of anesthetic drugs during operation and extubation time were compared between the two groups. Results The incidence of SIRS on the first day after operation in group N was 33.66%, which was lower than 40.82% in group P, but the difference was not statistically significant (P >0.05). There was no significant difference in MAP between the two groups at T1-T8 (P >0.05). HR at T2-T7 in group N was higher than that in group P (P <0.05). Except for T7, the number of cases with suitable depth of anesthesia in group N was more than that in group P at T2-T8, and the number of cases with too deep anesthesia was less than that in group P (P <0.05). The amount of propofol used in group N was less than that in group P, and the extubation time was shorter than that in group P (P <0.05). Conclusion Nicardipine has a satisfactory effect on controlled hypotension during orthognathic surgery, and it is helpful to maintain the appropriate depth of anesthesia and shorten the extubation time, but it has no significant effect on the incidence of postoperative systemic inflammatory response syndrome.