|
Link
http://www.anesthesia-analgesia.org/cgi/content/abstract/54/5/641
L. AMARANATH, M.D.*, H. F.
CASCORBI, M.D., Ph.D. ,
A. V. SINGH-AMARANATH, M.D. ,
and D. B. FRANKMANN, M.D.
*Assistant Professor, Department of
Anesthesiology, Case Western Reserve University School of Medicine,
Cleveland, Ohio 44106. Professor,
Department of Anesthesiology, Case Western Reserve University School of
Medicine, Cleveland, Ohio 44106. Fellow,
Department of Anesthesiology, Case Western Reserve University School of
Medicine, Cleveland, Ohio 44106. Assistant
Professor. Department of Anesthesiology, Case Western Reserve University
School of Medicine, Cleveland, Ohio 44106.
Abstract
Blood loss during total hip replacement has been reported as ranging from 500 to more than 4000 ml. To find reasons for this large variation, 167 case reports were studied. Blood loss was higher with nitrous oxide-oxygen-curare-morphine anesthesia than with halothane-nitrous oxide-oxygen. Blood loss was also higher in patients with cups, prostheses, and neoplasms of the femoral head and neck than in patients with degenerative and rheumatoid arthritis. In patients undergoing bilateral total hip replacement, operative blood loss was significantly (p
= 0.05) higher during the second operation. However, the most striking correlation of blood loss was with intraoperative
systolic blood pressure (r = 0.84), a finding
confirmed by a prospective study in 58 patients. Blood loss,
operative time, the number of blood transfusions, and the
hypotensive and hypoxic response to acrylic bone-cement
application decreased when intraoperative systolic blood
pressure was lowered by 20 to 30 percent of the preoperative
value by the use of trimethaphan or sodium nitroprusside.
This moderate reduction of blood pressure resulted in a saving of 2 to 3 units of blood in an average case and a considerably clearer surgical field. The authors consider moderate lowering of blood pressure to be a useful adjuvant in anesthesia for total hip replacement.
|
