title: Comparison of hypotensive epidural anesthesia and hypotensive total intravenous anesthesia on intraoperative blood loss during total hip replacement.
abstract: OBJECTIVE
  To compare hypotensive epidural anesthesia (HEA) and hypotensive total intravenous anesthesia (HTIVA) with propofol and remifentanil on blood loss during primary total hip replacement.
  
  
  METHODS
  Prospective, randomized clinical study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Forty ASA physical status I, II, and III patients presenting for primary total hip replacement.
  
  
  METHODS
  Patients received either HEA with bupivacaine (HEA group, n = 20) or HTIVA with propofol and remifentanil (HTIVA group, n = 20) to maintain mean arterial pressure between 50 and 60 mm Hg.
  
  
  METHODS
  Duration of hypotension, blood loss, blood transfusions, hemodynamics, and coagulation studies were recorded in both groups.
  
  
  RESULTS
  Intraoperative blood loss, percentage of patients receiving blood substitution, and total packed red blood cells transfused were less in those patients receiving HEA than those receiving HTIVA (P = .001, .04, and .015, respectively). Mean central venous pressure was lower in the HEA group than in the HTIVA group intraoperatively (P = .019). Mean hemoglobin concentrations and coagulation studies were similar between the groups. Neurologic examinations of all patients were intact in the postoperative period.
  
  
  CONCLUSIONS
  In spite the similar mean arterial pressure levels noted between groups, HEA results in less intraoperative blood loss than HTIVA during primary total hip replacement. This outcome may be associated with non-positive pressure ventilation, distribution of blood flow, and lower mean intraoperative central venous pressure in the HEA group.
authors.affiliation: Faculty of Medicine, Department of Anesthesiology and Reanimation, Karadeniz Technical University, 61080 Trabzon, Turkey. aheroglu@hotmail.com
authors.forename: Ahmet
authors.initials: A
authors.lastname: Eroglu
authors.forename: Halil
authors.initials: H
authors.lastname: Uzunlar
authors.forename: Nesrin
authors.initials: N
authors.lastname: Erciyes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007023:Hypotension, Controlled; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015742:Propofol; D011446:Prospective Studies
chemical_list: D018686:Anesthetics, Intravenous; D006454:Hemoglobins; D010100:Oxygen; D015742:Propofol