Deliberate Hypotension

Larson, Alexander

doi:10.1097/00000542-196409000-00018

Cited by 68 publications

(21 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most common complications were delayed wakening, blurred vision and reactionary (delayed) hemorrhage. 4,[7][8][9] Given the potential risks of this intervention, it has been reserved for healthy patients. The technique is not generally used in patients with a history of cardiac, cerebrovascular, renal, hepatic, or severe peripheral vascular disease, uncorrected hypovolemia, or severe anemia.…”

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

confidence: 99%

“…The results of the controlled studies are conflicting. Although there are a number of published review articles, 1,5,7,8, all suffer from major methodological limitations. 35 Lastly, none of the reviews attempted to obtain a quantitative estimate of the effect size of deliberate hypotension on blood loss and transfusion requirements.…”

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

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

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

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…First, the traditional style that keeps the patient in a light anesthesia with a secure airway and complete monitoring under a ganglion blocker or a vasodilator with a direct effect and, using this way, a beta blocker being used simultaneously is preferred [4] . The second method tries to control blood pressure without hypotensive drugs by increasing the depth of anesthesia, adequate ventilation and optimal position [5] . Reduction in bleeding is not only important to maintain the hemodynamic balance, but also creates better visibility for the surgeon during surgery; this issue is especially important (significant) in spinal cord surgery because important neuronal structures are located in the field.…”

Section: Introductionmentioning

confidence: 99%

Comparative induction of controlled circulation by magnesium and remifentanil in spine surgery

Ghodraty

Homaee

Farazmehr

et al. 2014

WJO

View full text Add to dashboard Cite

of blood loss, urine output, fluid intake and surgeon' s satisfaction were recorded. Data was analyzed with SPSS version 13.0 and P values less than 0.05 were considered significant. RESULTS:Twenty patients in the MGS group and 19 patients in the REM group were studied. There was no difference between the two groups in the hemodynamic variables, blood loss, urine output, fluid requirement and surgeon's satisfaction for exposure. The target MAP was achieved in 75% of Mg and 58% of remifentanil groups. Although a higher number of patients in the REM group required nitroglycerin (42.1%) to reach the target MAP than those in the MGS group (25%), this difference was not statistically significant (P = 0.32). CONCLUSION:Our findings showed that in patients undergoing lumbar PSF surgery, remifentanil and MGS have a similar hypotensive effect and comparable amount of blood loss without any significant adverse effects.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Controlled hypotension; Magnesium sulfate; Remifentanil; Spine surgery; Blood loss Core tip: We conducted a relatively small sized prospective randomized clinical trial comparing intravenous infusion of remifentanil with magnesium in controlling blood pressure during posterior spine fusion in order to decrease the intraoperative blood loss. Our experiments showed no difference between the two administered regimens in reducing mean arterial blood pressure and intraoperative blood loss, and satisfaction of the operating surgeons. METHODS:In this randomized clinical trial, 40 patients with the American Society of Anesthesiologists Ⅰ and Ⅱ physical status undergoing lumbar PSF were randomized to receive remifentanil (REM) 0.15 μg/kg or MGS 50 mg/kg for controlled hypotension. The administering anesthesiologist was blinded to the medication. Continuous infusion was maintained at a fixed volume rate to deliver precalculated doses of either study drugs. All other aspects of anesthesia and surgery were similar in the two groups. The target mean arterial pressure (MAP) range used in this study was 60-70 mmHg. In the course of surgery, the hemodynamic variables, volume BRIEF ARTICLE

show abstract

“…A significant and most frequently complication encountered intraoperatively is blood loss(8,) (9). It has been assessed that 50% of a surgeon's time and a great deal of nervous energy is spent in controlling bleeding (10). Bleeding is the quantity of blood that appears in the operative field in a given time period and it can be expressed in flow 'D' (volume/unit of time) and is mathematically related to the pressure by the relationship, D = P/R, where 'P' is pressure and 'R' represents vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Limiting blood loss in orthognathic surgery with Esmolol as a hypotensive agent

Mukul¹,

Kumar²,

Mokhtar³

et al. 2017

jaar

View full text Add to dashboard Cite

Orthognathic surgery may be complicated by difficulty in achieving hemostasis because unlike soft tissue, the vessels traversing bone cannot be identified and isolated before osteotomy. In this study we evaluated the amount of blood loss and duration of surgery under deliberate hypotensive anesthesia in comparison to amount of blood loss and duration of surgery under normotensive anesthesia on patients undergoing orthognathic surgical procedures. A total of 16 cases undergoing orthognathic surgery were included in this clinical study. Patients were randomly grouped under normotensive (group I) or hypotensive group (group 2). Patients in hypotensive anesthesia group were given Esmolol to maintain mean arterial pressure in the range of 70-80 mm of Hg till osteotomy segments were fixed. There was more than 40% reduction in blood loss in orthognathic surgical procedures when induced hypotension was used, but there was not statistically significant (p=0.91) reduction in the operative time. Based on surgeons and anesthetist's assessment fast acting agents like Esmolol can be used intraoperatively to induce hypotension as and when required.

show abstract

Deliberate Hypotension

Cited by 68 publications

References 0 publications

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

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

Comparative induction of controlled circulation by magnesium and remifentanil in spine surgery

Limiting blood loss in orthognathic surgery with Esmolol as a hypotensive agent

Contact Info

Product

Resources

About