Prostaglandin E1 as a hypotensive drug during general anesthesia for total hip replacement.
OBJECTIVE
To determine the effect of intravenous administration of prostaglandin E1 (PGE1) in inducing controlled hypotension during general anesthesia.


METHODS
Randomized, prospective study.


METHODS
Inpatient surgery at a university hospital.


METHODS
57 ASA physical status I and II patients scheduled for total hip replacement.


METHODS
In 29 patients undergoing total hip replacement, PGE1 (0.11 +/- 0.03 micrograms/kg/min) was infused to induce hypotension during general anesthesia with enflurane, isoflurane, or sevoflurane in nitrous oxide and oxygen. In another 28 patients, the control group, normotensive anesthesia was performed for the same procedure.


RESULTS
Systolic blood pressure decreased significantly (p < 0.01) from 136 +/- 22 mmHg to 93 +/- 10 mmHg during PGE1 infusion, although heart rate did not change significantly. Arterial hemoglobin oxygen saturation showed a mild but significant decrease (p < 0.05) during PGE1 infusion. Blood loss (480 +/- 132 ml) and blood transfusion (280 +/- 260 ml) during surgery were significantly less in patients with hypotensive anesthesia (p < 0.01 and p < 0.05, respectively) than in patients with normotensive anesthesia (667 +/- 326 ml and 468 +/- 395 ml, respectively). Blood loss and blood transfusion after surgery were similar in both groups. In the recovery room or surgical ward, 3 of 29 patients with hypotensive anesthesia needed rapid blood transfusion because of moderate hypotension. The volume of urine during surgery was significantly less (p < 0.05) in the control group. Two patients developed mild phlebitis at the site of the PGE1 infusion, but there were no serious side effects.


CONCLUSIONS
These data suggest that PGE1 can be used safely to induce hypotension, thereby reducing blood loss during total hip replacement with general anesthesia.
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Japan.
H
H
Yukioka
K
K
Asada
M
M
Fujimori
A
A
Shimazu
D000527:Alprostadil / Q000008:administration & dosage*; D000768:Anesthesia, General; D000777:Anesthetics; D004737:Enflurane; D004987:Ethers; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007023:Hypotension, Controlled; D007262:Infusions, Intravenous; D007530:Isoflurane; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D009609:Nitrous Oxide; D010100:Oxygen; D011446:Prospective Studies; D000077149:Sevoflurane
D000777:Anesthetics; D004987:Ethers; D008738:Methyl Ethers; D000077149:Sevoflurane; D004737:Enflurane; D007530:Isoflurane; D000527:Alprostadil; D009609:Nitrous Oxide; D010100:Oxygen