Abstract
BackgroundHypotensive epidural anaesthesia (HEA) combines a high epidural anaesthesia, performing a sympathetic blockade, with low-dose iv-infusion of epinephrine to stabilize circulation in the conscious patient. Mean artery blood pressure is reduced to 45–50 mmHg and hereby a reduced blood loss. In this study we have combined HEA with preoperative acute normovolaemic hemodilution (ANH) in attempt to further reduce the blood loss and need for blood transfusion in total knee arthroplasty surgery (TKR).MethodsTwenty-eight patients scheduled for TKR are randomised to ANH or no hemodilution (non-ANH). Both groups are anaesthetized with HEA. ANH is established with predonation of 20 % of the total blood volume, and replacement with equal volume of HAES 6 %. Blood re-transfusion is completed within 6 h.ResultsA mean of 877 ml blood was predonated (19.7 % of the total blood volume). Blood loss was, except from the intraoperative loss, significantly higher in ANH group. The total loss was 1306 mL (ANH) vs. 1026 mL (non-ANH), p < 0.05. Except from the first hour postoperatively, hematocrit was identical in between groups postoperatively. The amount of blood transfusion was identical 386 ml (ANH) vs. 343 ml (non-ANH) (ns). 50 % went through surgery without receiving blood (ANH) vs. 58 % (non-ANH). No renal, neurological or cardiopulmonary complications were registered.ConclusionsThese data suggest no benefits in combining HEA and ANH in TKR surgery. Probably because of the reduced viscosity of the blood after ANH, there is an increased postoperative blood loss. The need for homologous blood transfusion was identical.
Highlights
Hypotensive epidural anaesthesia (HEA) combines a high epidural anaesthesia, performing a sympathetic blockade, with low-dose iv-infusion of epinephrine to stabilize circulation in the conscious patient
A mean arterial blood pressure (MAP) of 55–60 mmHg has been regarded as the lowest safe level in young healthy patients, one of the reasons being that this range represents the lowest MAP at which auto regulation of the cerebral blood flow is still active
The aim of this study was to evaluate the potential benefits of a reduced need for homologous blood transfusion by combining HEA and acute normovolaemic hemodilution (ANH) in total knee arthroplasty surgery (TKR) surgery
Summary
Hypotensive epidural anaesthesia (HEA) combines a high epidural anaesthesia, performing a sympathetic blockade, with low-dose iv-infusion of epinephrine to stabilize circulation in the conscious patient. Mean artery blood pressure is reduced to 45–50 mmHg and hereby a reduced blood loss. In this study we have combined HEA with preoperative acute normovolaemic hemodilution (ANH) in attempt to further reduce the blood loss and need for blood transfusion in total knee arthroplasty surgery (TKR). The risks associated with banked homologous blood products are well known. These risks include among others: ABO incompatibilities, viral or bacterial infections, and immunosuppression [1]. The concept of decreasing the arterial blood pressure to hypotensive levels during anaesthesia and surgery has been used for decades in attempt to reduce intraoperative blood loss and to improve conditions in the surgical field. A mean arterial blood pressure (MAP) of 55–60 mmHg has been regarded as the lowest safe level in young healthy patients, one of the reasons being that this range represents the lowest MAP at which auto regulation of the cerebral blood flow is still active
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