title: Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: John
authors.initials: J
authors.lastname: Hanson
authors.forename: Brendan T
authors.initials: BT
authors.lastname: Finucane
mesh_terms: 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