THIS ARTICLE HAS BEEN RETRACTED Acute phase response to nitroprusside‐induced controlled hypotension in patients undergoing radical prostatectomy

Abstract

SummaryThis study evaluated the effects of sodium nitroprusside-induced controlled hypotension on the acute phase response in patients undergoing radical prostatectomy. Thirty patients were randomly allocated to two groups, a hypotension group (mean arterial blood pressure was adjusted to 50 mmHg) and a control group (mean arterial blood pressure > 70 mmHg). C-reactive protein increased signi®cantly in the hypotension group from 0.13 (0.23) to 9.85 (2.84) mg.ml À1 and in the control group from 0.15 (0.27) to 7.38 (3.02) mg.ml À1 . In both groups, serum amyloid A increased signi®cantly, but levels were higher in the hypotension group [585 (125) mg.l À1 ] than in the control group [460 (187) mg.l À1 ]. Interleukin-6 increased signi®cantly in both groups, but was higher in the hypotension group [139 (124) pg.ml À1 ] than the control group [56 (27) pg.ml À1 ]. Elastase showed no signi®cant changes in the control group but in the hypotension group there was a signi®cant increase from 65 (51) to 122 (75) ng.ml À1 . Sodium nitroprusside-induced hypotension was associated with a more pronounced acute phase reaction.

Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery

“…Although this finding is similar to other recent publications of deliberate hypotension, [6][7][8] it is clear that a zero numerator (no SAEs in a study population) does not imply zero risk. In this study population the risk of an SAEs was less than 3%.…”

“…25 There is evidence that nitroprusside-induced hypotension is associated with a significant increase in acute phase proteins. 7 This finding may indicate transient gut ischemia secondary to hypotension, although a further study of patients undergoing maxillo-facial surgery (with controlled hypotension using isoflurane or esmolol/nitroglycerin), found that gastric intramucosal pH values remained above 7.37 leading to the conclusion that splanchnic perfusion was not compromised. 8 Overall, these findings suggest that deliberate hypotension may be applied to patients who are carefully selected, based on appropriate exclusion criteria.…”

“…1 Two other studies 6,7 have reported allogeneic transfusion rates of 25% and 0% among patients undergoing deliberate hypotension with sodium nitroprusside. The latter study demonstrated a reduction in blood loss and overall number of units transfused throughout the study in comparison to controls, but failed to show statistical significance in terms of the proportion of patients receiving allogeneic blood.…”

Hat die kontrollierte Hypotension einen Stellenwert im Rahmen fremdblutsparender Verfahren?

“…Weiterhin wird das Verfahren eingesetzt, um ein weitgehend blutleeres Operationsfeld zu schaffen, dem Operateur damit das Vorgehen zu erleichtern (z. Bisher publizierte Untersuchungen [2,5,8,9,10,11] zeigen auf, dass selbst mit einer Absenkung des MAP auf etwa 50 mmHg nicht alle Patienten mit einer nennenswerten Verminderung des intraoperativen Blutverlusts im Vergleich zu "normotensiven Patienten" reagieren, Bei der Ausschaltung intrakranieller Aneurysmen soll durch die Anwendung der "kontrollierten Hypotension" die Wandspannung im Aneurysma herabgesetzt und damit die Rupturgefahr vermindert werden.…”

Blood loss and endocrine responses in hypotensive anaesthesia with sodium nitroprusside and nitroglycerin for mandibular osteotomy

“…Sodium nitroprusside (SNP) 6,16 and nitroglycerin (NTG) 5,17 are often used for hypotensive anaesthesia because they are potent vasodilators with predictable, short-acting and easily reversible effects. A significant reduction in blood loss 20 and an improvement in the quality of the surgical field 18 have been achieved with controlled hypotensive anaesthesia induced using SNP or NTG.…”