Abstract
BackgroundThe effects of restrictive fluid therapy combined with controlled hypotension in the elderly on systemic oxygen metabolism and renal function are clinical concerns. The aim of this study was to evaluate blood loss, oxygen metabolism, and renal function in different levels of controlled hypotension induced by intravenous nitroglycerin, in combination with limited infusion, in elderly patients undergoing posterior lumbar fusion.MethodsA total of 40 patients, aged 60–75 with ASA grade II or III, who were planned for posterior lumbar fusion were randomly allocated into two groups: experimental group [target mean arterial pressure 65 mmHg (MAP 65) or control group (MAP 75)]. Indicators for blood loss, hemodynamic, systemic oxygen metabolism, and renal function evaluation index were recorded before operation (T0), 1 h after induced hypotension (T1), 2 h after hypotension (T2), and in recovery (T3). We compared changes in these parameters between groups to evaluate the combined effects of controlled hypotension with restrictive infusion.ResultsCI, DO2I, and VO2I were lower in both groups at T1–T3 compared with T0 (p < 0.05). DO2I and VO2I in the MAP 65 group were lower than the MAP 75 group after operation. In both groups, SCysC increased at T1, T2, and T3 (p < 0.05) compared with T0.ConclusionsRestrictive transfusion and control MAP at 65 mmHg can slightly change in renal function and reduce the risk of insufficient oxygen supply and importantly have no significant effect on blood loss and postoperative complications.Trial registrationChiCTR-INR-16008153. Registered on 25 March 2016.
Highlights
The effects of restrictive fluid therapy combined with controlled hypotension in the elderly on systemic oxygen metabolism and renal function are clinical concerns
Patients A total of 144 elderly patients were scheduled to undergo selective posterior lumbar fusion during the study period, with 102 cases were excluded for different reasons
One patient in the mean arterial pressure (MAP) 65 group for whom the operation time was more than 4 h and one case in the MAP 75 group with intraoperative blood loss larger than 1500 ml were excluded, resulting in 40 patients, 20 in each group, in the final analysis (Fig. 1)
Summary
The effects of restrictive fluid therapy combined with controlled hypotension in the elderly on systemic oxygen metabolism and renal function are clinical concerns. The aim of this study was to evaluate blood loss, oxygen metabolism, and renal function in different levels of controlled hypotension induced by intravenous nitroglycerin, in combination with limited infusion, in elderly patients undergoing posterior lumbar fusion. Bleeding during operation affects the clarity of operation field which may prolong operation, and increases the risk of requirement of allogeneic blood transfusion, which could hinder postoperative rehabilitation [7]. Controlled hypotensive anesthesia is one of the most effective methods to reduce bleeding during surgery [8]. The advantages of controlled hypotension in reducing intraoperative blood loss in spinal surgery have been widely recognized [9, 10]. It has been proved to result in less blood loss and requirement of blood transfusion [11]
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