The effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty performed under lumbar epidural anesthesia.
The degree of induced hypotension necessary to achieve a significant reduction in intraoperative blood loss has never been defined. Forty patients undergoing primary total hip arthroplasty during epidural anesthesia by a single surgeon were randomly assigned to have mean arterial pressure maintained at 50 +/- 5 mm Hg or 60 +/- 5 mm Hg throughout surgery. Intraoperative blood loss was 179 +/- 73 mL in the 50 mm Hg group and 263 +/- 98 mL in the 60 mm Hg group (P = 0.004). Subjectively, there was more bleeding during surgery in the 60 mm Hg group during dissection of the hip joint (P = 0.0026) and while reaming the acetabulum (P = 0.0001) and femur (P = 0.0001). No difference in transfusion requirements, postoperative hematocrit, or duration of surgery was noted. A difference in mean arterial blood pressure of 10 mm Hg from 50 to 60 mm Hg during surgery for total hip arthroplasty under epidural anesthesia has a measurable effect on intraoperative blood loss.
Sharrock
N E
NE
Department of Anesthesiology, Hospital for Special Surgery, New York, New York 10021.
Mineo
R
R
Urquhart
B
B
Salvati
E A
EA
D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D016063:Blood Loss, Surgical; D001810:Blood Volume; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007023:Hypotension, Controlled; D008297:Male; D008875:Middle Aged