[Effect of anesthesia technique on blood loss in breast reduction-plasty. A study of 56 patients operated on by one surgeon].
Since we had the impression that there was an increase in blood loss during mammaplasties after a change in the anesthesiology department responsible, we conducted a study to compare 28 cases from each anesthesiology department. All operations were carried out by the first author in succession using the same operative technique. The two groups did not differ in age, BMI, operative time, weight of resected tissue or preoperative laboratory. Blood loss was calculated from the perioperative drop in hemoglobin and patient's blood volume. Blood pressure, heart rate, medication and intravenous fluid supply were obtained from the anesthetic protocols.
Group I (n = 28) and [Group II (n = 28)]: total resected tissue 1862 +/- 928 g [1912 +/- 791 g]; Hb-preop. 13.6 +/- 0.9 g/dl [13.8 +/- 0.8 g/dl]; Hb-postop. 10.8 +/- 1.3 g/dl [9.7 +/- 1.3 g/dl] P = 0.006; Blood loss 970 +/- 339 ml [1443 +/- 456 ml] P < 0.001. After exclusion of surgical or biological causes hemodynamic effects of the anesthetic techniques were suspected as the reason for the significant difference in blood loss. MAP was elevated only initially, while the heart rate was considerably elevated throughout the procedures in group II. During anesthesia with nitrous oxide and enflurane, the dose of enflurane in group I could be limited to 0.3-0.5% after initial i.v. administration of 60 to 100 micrograms sufentanil, while in group II without opioids doses of 0.5-2% were required. The well-known dose-dependent effect of enflurane on the peripheral vascular tone was not masked by vasoconstrictors at the operative site.


CONCLUSIONS
Blood loss during mammaplasties can be affected considerably by the anaesthetic technique--even without deliberate hypotension. Sufentanil can indirectly reduce the blood loss by lowering the necessary dose of enflurane. Blood transfusions can be avoided at mammaplasties.
Kuipers
T
T
Abteilung für Plastische Chirurgie, Marienhospital Stuttgart.
Stocker
H J
HJ
Gubisch
W
W
Greulich
M
M
D000328:Adult; D000769:Anesthesia, Inhalation; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000503:physiopathology* / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004737:Enflurane; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D009609:Nitrous Oxide; D017409:Sufentanil
D004737:Enflurane; D017409:Sufentanil; D009609:Nitrous Oxide