Combined hemodilution and hypotension monitored with jugular bulb oxygen saturation, EEG, and ECG decreases transfusion volume and length of ICU stay for major orthopedic surgery

Journal of Clinical Anesthesia
Y ShapiraI Meller

Abstract

To assess the efficacy and safety of hemodilution combined with induced hypotension during surgery. Randomized, nonblinded, controlled study. Operating room suite and intensive care unit (ICU) at a university hospital. 16 ASA physical status I and II patients who underwent general or general plus epidural anesthesia for major orthopedic surgery. In Group 1 (n = 10), mean arterial blood pressure (MAP) was decreased to 50 mmHg by increasing the inspired concentration of isoflurane and injecting 75 mg of 0.5% bupivacaine into the epidural catheter. Hematocrit was decreased to 20% by phlebotomy and simultaneous infusion of crystalloid and colloid. In Group 2 (n = 6), isoflurane was adjusted to maintain MAP within 20% of baseline values, and no phlebotomy or hemodilution was used. Efficacy of hemodilution combined with induced hypotension (Group 1) was compared to standard management of blood volume and pressure (Group 2) by measuring transfusion volume and length of ICU stay. Safety of hemodilution/hypotension was determined by measuring the electroencephalogram, internal jugular venous oxygen saturation, the electrocardiogram, and central venous oxygen saturation. In Group 1, both the volume of homologous blood (225 +/- 150 ml) an...Continue Reading

References

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Citations

Oct 16, 2007·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·James Edward PaulLehana Thabane
Jun 17, 2009·Archives of Orthopaedic and Trauma Surgery·Wieger Geert HorstmannCees C P M Verheyen
Jun 14, 2005·Journal of Clinical Anesthesia·Charles Weissman

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