Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery.
OBJECTIVE
Radical prostatectomy is associated with substantial blood loss frequently requiring allogeneic blood transfusion. We investigated the efficacy of deliberate hypotension using combined epidural/general anesthesia in reducing allogeneic transfusion requirements in patients undergoing radical prostatectomy.


METHODS
In a prospective, randomized, single-blind trial, 102 patients undergoing radical prostatectomy were allocated to either an epidural group (n = 51) or a control group (n = 51). In the epidural group, deliberate hypotension was achieved with a target mean arterial pressure of 55-60 mmHg. The trigger for allogeneic blood transfusion in both groups was a hematocrit value < 0.25.


RESULTS
Operative blood loss in the epidural group was significantly less than that in the control group (955 +/- 517 mL vs 1477 +/- 823 mL respectively, P < 0.001). The percentage of patients who reached the threshold trigger for allogenic transfusion was significantly less in the epidural group (8% vs 26%, respectively, P = 0.019) and the number of patients who were actually transfused during hospitalization was also significantly less (P = 0.028). There were no serious adverse events in either group during the study.


CONCLUSIONS
Controlled hypotension using a combined epidural/ general anesthetic technique is associated with significantly less blood loss, and a reduction in the use of allogeneic blood in patients undergoing radical prostatectomy compared to general anesthesia alone.
O'Connor
Paul J
PJ
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
Hanson
John
J
Finucane
Brendan T
BT
D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004562:Electrocardiography; D006801:Humans; D007023:Hypotension, Controlled; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D016037:Single-Blind Method