Deliberate hypotension as a mechanism to decrease intraoperative surgical site blood loss in resource limited setting: A systematic review and guideline

Abstract

Introduction: Intraoperative surgical site bleeding is usually common in different types of surgeries. Even though there are different prevention techniques for intraoperative bleeding disorder, now adays deliberate hypotension is highly recommended as management options. Uncontrolled intraoperative bleeding may contribute to disability and even death. It can be the initial sign, and lead to incapacitating symptoms in patients undergoing moderate to major surgery. Method: Electronic search strategies used the following databases: Cochrane library, Pub Med, Medline and various internet search routines, for English publications. Key search terms included in our review are: Deliberate/controlled/induced/permissive hypotension, Intraoperative blood loss, Bleeding control, Intraoperative monitoring, Complication and anesthetic management. Availability of each referenced literature database was assessed until March 15–2019. References classified by evidence levels were selected by one individual and checked by another investigator. Discussion: Deliberate hypotension is listed as one of the blood conservation techniques to be considered with MAP between 50 and 65 mmHg and SBP between 80 and 90 mmHg with little to no reports of complication. A reduction of the patient's blood pressure improved the surgical field operating conditions. Resuscitation should be started after bleeding sites arrested. The most significant factor in deciding when to transfuse is based on one's attitude towards transfusion and the related ‘trigger’ criterion for transfusion. Conclusion: Hypotensive anesthesia protocol allowed perfect hemostasis control significantly with shorter operative time compared with other intraoperative controlling mechanisms for prevention of surgical site bleeding. The range of mean arterial pressure and blood pressure has to be closely monitored and any decrement from the expected range should be managed with vasoactive drugs. Highlights

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