The combination of hemodilution and controlled hypotension: physiology and clinical application

Acute Hemodilution is Safe in Patients with Comorbid Illness Undergoing Partial Hepatectomy

“…It could be considered in pancreatic or other major intra-abdominal surgery; however, caution must be exercised because there is evidence to suggest that patients should not be kept under these anesthetic constraints for more than 120 minutes. 2 In our practice, we do not maintain AH with low CVP anesthetic conditions during extrahepatic resection.…”

“…The safety in patients with cardiovascular disease is thought to be dependent on degree of anemia and ability to maintain normovolemia. 2 Hematocrit less than 25 per cent is associated with increased major morbidity in patients undergoing cardiopulmonary bypass 3 and the goal hemoglobin for dilutional anemia remains under debate. 4 Applying AH to patients undergoing partial hepatectomy is complicated by the desire to maintain a low central venous pressure (CVP) during hepatic parenchymal transection.…”

Human middle cerebral artery flow velocity during controlled hypotension combined with hemodilution—transcranial Doppler study

“…Controlled hypotension was induced by prostaglandin E 1 (PGE 1 ) at a rate of 0.15 to 0.25 lg/kg per minute according to previous studies [7,8], and MAP was maintained at approximately 55 mm Hg for 80 minutes during surgery. The degree of hemodilution and hypotension was adopted from the literature [8][9][10][11]. The drawn blood was transfused in each group after the end of the controlled hypotension.…”

Patient Blood Management

“…In addition, maintaining body temperature above 35 °C (to prevent coagulopathy), and controlled hypotension with a mean arterial pressure of 50-55 mmHg also reduce intraoperative blood loss (Fukusaki et al 1997 ;Fukusaki and Sumikawa 2000 ;Theusinger et al 2012 ). Maintaining postoperative mean arterial pressure between 60 and 70 mmHg is recommended (Emmert et al 2011 ).…”