Complications Associated With the Use of "Controlled Hypotension" in Anesthesia

Hampton, Louis J.; Little, David M.

doi:10.1001/archsurg.1953.01260040558009

Cited by 47 publications

(13 citation statements)

References 10 publications

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“…While the death rate from hypotensive anaesthesia in Great Britain was stated to be 1 in 459 by Hampton and Little (1953), it is probable that the incidence of complications, particularly neurological and psychiatric, is greater. Bedford (1955) has drawn attention to the existence of dementia, particularly in minor degrees, as a complication of anaesthesia in the elderly (with hypotension among the aetiological factors), but the present case indicates that, under certain conditions, the risk exists for the substantially younger, healthy adult.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Complications of Hypotensive Anaesthesia in a Healthy Adult

Brierley¹,

Cooper²

1962

Journal of Neurology, Neurosurgery & Psychiatry

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The employment of deliberately induced hypotension with the purpose of reducing haemorrhage or oedema is a procedure that does not yet receive the unequivocal endorsement of all anaesthetists and surgeons. The There was no change until the sixth post-operative day when occasional flexor spasms of the spine were noted and there was more response to stimulation.By the twelfth day, there appeared to be some fixation of the eyes on nearby objects, and, although tone was increased in the arms, the tendon reflexes were reported as normal. On the twenty-first post-operative day, the patient seemed to comprehend simple instructions and began to take food slowly by mouth.Neurological examination at three and a half weeks showed normal fundi and equal and reactive pupils. All four limbs were spastic but some voluntary movement was present and was stronger on the right. Pin-prick was felt on both sides of the body and both plantar responses were extensor. Slow improvement continued and, five weeks after the operation, the patient began to say 'yes' and 'no' in reply to simple questions and to regain bowel and bladder control.At six weeks, walking was possible with assistance but as speech returned it was apparent that there was disorientation and a gross memory deficit for both past and present events. Emotional lability developed with violent temper tantrums at minor frustrations.Slow improvement was maintained, and four months after the operation, the patient knew her name and that she was in hospital, but not the date, her address, or the name of the hospital. She could converse about very simple matters but confabulated freely when asked how she spent the time. Her speech was slurred but there was no dysphasia. All limbs were hypertonic with exaggerated reflexes. She walked in a flexed manner without swinging her arms. The left side was slightly weaker than the right and no sensory loss was found. The plantar reflexes were equivocal.

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Section: Discussionmentioning

confidence: 99%

Cerebral Complications of Hypotensive Anaesthesia in a Healthy Adult

Brierley¹,

Cooper²

1962

Journal of Neurology, Neurosurgery & Psychiatry

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“…4 Initial enthusiasm for the technique waned following a report by Hampton and Little, describing a morbidity of 3.20% and a mortality of 0.34% based on 27,930 cases. 5,6 Subsequent morbidity was reported at 2.5% and mortality between 0.02% and 0.60%. The most common complications were delayed wakening, blurred vision and reactionary (delayed) hemorrhage.…”

Section: Conclusion : Ce Compte-rendu Soutient Dans Une Certaine Mesumentioning

confidence: 99%

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

Paul

Ling

Lalonde

et al. 2007

Can J Anesth/J Can Anesth

114

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Purpose: To determine if deliberate hypotension decreases blood loss and transfusion requirements in patients undergoing orthopedic surgery, a systematic review of all randomized trials addressing this issue was undertaken.Methods: Electronic databases, citations lists and review articles were searched for potential articles. Relevant articles met the following inclusion criteria: English language, humans undergoing orthopedic surgery, deliberate hypotension used by any method, intraoperative blood loss measured as an outcome, and the trial methodology being randomized and controlled. Four outcomes were analyzed, including estimated blood loss, blood transfused, surgery duration, and quality of the surgical field. For all analyses, the random-effects model was used.Results: Seventeen articles met the inclusion criteria. The surgeries studied included total hip arthroplasty (seven), orthognathic surgery (eight), total knee arthroplasty (one) and spinal fusion (one). A total of 636 patients were randomized across all studies. For blood loss, the overall weighted mean difference favoured treatment, with a savings of about 287 mL of blood [95% confidence interval (CI): -447, -127]. The mean differences also showed a statistically significant benefit for deliberate hypotension in reducing transfusion requirements (-667 mL of blood transfused; 95% CI: -963, -370). Deliberate hypotension was not shown to reduce the duration of surgery (-1.9 min of surgery; 95% CI: -7.2, 3.5) or improve surgical conditions (surgical field quality rating -0.5; 95% CI: -1.1, 0.2). Conclusion:This review provides some support for the use of deliberate hypotension in reducing blood loss and transfusion requirements in orthopedic surgery, but these results are tempered by the small sample sizes and poor methodological quality of published studies.

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“…In earlier years, reports on the use of induced hypotension as a surgical adjunct included the conclusion that 60 mm Hg was the safe minimum in normotensive subjects, 40 -41 that a rate of reduction of mean arterial pressure of 10 mm Hg per minute was the safe maximum 42 44 especially in those conditions where vasodilatory action of the brain's vasculature is compromised. 41 ' "…”

mentioning

confidence: 99%

Evoked potential changes during brain retraction in dogs.

Bennett¹,

Albin²,

Bunegin³

et al. 1977

Stroke

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SUMMARY Brain retraction and induced hypotension are surgical adjuncts capable of compromising cerebral blood flow. To evaluate their effects upon brain function, cortical evoked potentials, neurological status and cortical histological changes were determined as a function of graded levels of brain retractor and systemic perfusion pressure in the dog.Somatosensory evoked potentials recorded from the site of application of brain retraction showed a decrement as a function of both the amount of retraction pressure and the systemic perfusion pressure. An electrode distant from the retractor site showed similar, though reduced and more variable changes in amplitude. For higher levels of brain retractor pressure, induced hypotension to 50 mm Hg systemic perfusion pressure produced greater reductions in evoked potentials than in normotensive subjects. It was demonstrated that a reduction of 50% of the evoked potential amplitude after sixty minutes brain retraction signaled, with high probability, the occurrence of postoperative sensory and/or motor deficits and cortical histopathology. It was concluded that cortical evoked potentials represent a reliable indicator of the functional effects produced by applied cortical retraction pressure at several levels of systemic perfusion pressure. It was suggested that the recording of evoked potentials would prove most useful during neurosurgical procedures employing induced hypotension and brain retraction.GIVEN THE LIMITS of the autoregulatory capacity of the brain, 1 " 7 surgical adjuncts which can compromise cerebral blood flow may be critically important considerations, especially in patients with suspected or demonstrated brain pathology. Two such procedures are brain retraction and induced hypotension. Both are factors affecting cerebral vascular transmural pressure; 3 the first a force directed from the outside and the latter a reduction in the force directed from the inside of the vessel. The potential deleterious effects of combining the two procedures are widely recognized. However, no investigation of their combined effects upon brain function has been reported. The present study attempts to provide data on changes in three measures of brain function following experimental induction of hypotension and brain retraction. These data may be especially relevant to the surgical treatment of cerebral vascular tumors and anomalies wherein both induced hypotension and brain retraction are employed in combination. 818To evaluate the effects of these two factors acutely we have chosen to monitor brain function with measurement of somatosensory evoked potentials (SEP) during the application of various levels of brain retraction (P r ) and systemic perfusion pressure (SPP) in the dog. To test for the subsequent effects of these procedures and to assess the significance of acutely observed SEP changes, postoperative neurological status and brain histologic changes were evaluated.Evoked potentials were selected as the monitor of the effects of brain retraction since they have bee...

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Complications Associated With the Use of "Controlled Hypotension" in Anesthesia

Cited by 47 publications

References 10 publications

Cerebral Complications of Hypotensive Anaesthesia in a Healthy Adult

Cerebral Complications of Hypotensive Anaesthesia in a Healthy Adult

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

Evoked potential changes during brain retraction in dogs.

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