Comparative Effects of Induced Hypotension and Normovolaemic Haemodilution on Blood Loss in Total Hip Arthroplasty

Abstract

The effects of deliberate hypotension and normovolaemic haemodilution on operative blood loss were studied in patients undergoing hip arthroplasty. Thirty patients were anaesthetized with halothane-nitrous oxide, and assigned to one of three groups. In group I, mean arterial pressure was decreased to 55 mm Hg by sodium nitroprusside. In group II, 23 +/- 2 ml/kg of blood was withdrawn just before the surgical procedure and replaced by twice volume with 4% albumin and Ringer lactate solution. The shed blood was reinfused at the end of the surgical procedure. In group III, the blood replacement was equal to blood loss and this group served as control. Intraoperative blood losses were 1050 +/- 185 ml and 900 +/- 130 ml in the autotransfused and control groups, respectively, and 320 +/- ml in the hypotensive group. However, the total red cell loss was significantly less in the hypotensive and autotransfused groups than in the control group. No complications occurred any of the three groups. Deliberate hypotension was the most effective means of reducing intraoperative bleeding and the time for this procedure was shorter than for normovolaemic haemodilution combined with autotransfusion.

Deliberate hypotension in orthopedic surgery reduces blood loss and transfusion requirements: A meta-analysis of randomized controlled trials

“…After detailed review of all eligible articles, 17 met the inclusion criteria. 7,12,15,[40][41][42][43][44][45][46][47][48][49][50][51][52][53] The weighted kappa on agreement between the reviewers in identifying eligible articles was 0.87, which is consistent with near perfect agreement. Reasons for excluding the potentially relevant articles included the wrong population, the wrong intervention, no control group, estimated blood loss not recorded as an outcome, subjects not randomized to treatment groups, and the article being a review or editorial.…”

“…Two studies investigated the cointervention of hemodilution in addition to deliberate hypotension. 40,44 In one study, the first control group received hemodilution (excluded from analysis) and a second control group did not. 40 In the other study, two treatment groups received deliberate hypotension and one group also received hemodilution during surgery; the treatment group that received hemodilution was excluded from the analysis.…”

“…40,44 In one study, the first control group received hemodilution (excluded from analysis) and a second control group did not. 40 In the other study, two treatment groups received deliberate hypotension and one group also received hemodilution during surgery; the treatment group that received hemodilution was excluded from the analysis. 44 The intraoperative mean blood pressure of the treatment and control groups was described by 16 of the studies; the remaining study reported the maintaining of blood pressure within 75% of baseline value for the treatment group.…”

“…The transfusion trigger was not reported in eight of the studies, 7,12,15,[41][42][43]51,52 it was left to the discretion of the attending anesthesiologist in two studies 49,50 and it was explicitly stated in the remaining seven studies. 40,[44][45][46][47][48]53 In the studies which described the transfusion triggers, the triggers included volume of blood loss (300-400 mL), hematocrit thresholds (28-30%), and percentage of blood volume lost (20%).…”

“…Fourteen of the 17 studies advocated the use of deliberate hypotension in the discussion. 7,15,[40][41][42][45][46][47][48][49][50][51][52] Three studies reported the numbers of patients that did and did not receive any blood transfusion. 40,43,46 Overall, the incidence of receiving a blood transfusion in the hypotensive groups was 55.8% vs 78.7% in the control groups.…”