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Anesthesia Considerations: Hypotension and Hemodilution

  • Nigel E. Sharrock

Abstract

There has been an ever-increasing interest in avoiding allogeneic blood transfusion. This began with the recognition of the risk of both hepatitis B virus transmission and transfusion reactions. Currently, concerns have focused on transmission of HIV, hepatitis C or Yersinia. In addition, there are immunologic consequences to transfusion, and an increased risk of infection in patients who are transfused.1 Finally, cost has become an issue. These multiple concerns have brought patients, surgeons, physicians, anesthesiologists, hematologists, and hospital administration personnel together (for a change) in a concerted effort to reduce the use of allogeneic transfusions.2 This chapter deals with three techniques that can have a major impact on transfusion requirements after total hip arthroplasty (THA).

Keywords

Mean Arterial Pressure Transfusion Requirement Allogeneic Blood Transfusion Homologous Blood Transfusion Trigger 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Landers DF, Hill GE, Wong KC, Fox U. Blood transfusion-induced immunomodulation. Anesth Analg. 1996;82: 187–204.PubMedGoogle Scholar
  2. 2.
    Weiskopf RB. More on the changing indications for transfusion of blood and blood components during anesthesia: editorial views. Anesthesiology. 1996;84:498–501.PubMedCrossRefGoogle Scholar
  3. 3.
    McLoughlin TM Jr, Fontana JL, Alving B, Mongan PD, Bunger R. Profound normovolemic hemodilution: hemostatic effects in patients and in a porcine model. Anesth Analg. 1996;83:459–465.PubMedGoogle Scholar
  4. 4.
    Habler OP, Kleen MS, Podtschaske AH, Hutter JW, Tiede M, Kemming GI, et al. The effect of acute normovolemic hemodilution (ANH) on myocardial contractility in anesthetized dogs. Anesth Analg. 1996;83:451–458.PubMedGoogle Scholar
  5. 5.
    Mielke LL, Entholzner EK, Kling M, Breinbauer BE, Burgkart R, Hargasser SR, et al. Preoperative acute hypervolemic hemodilution with hydroxyethylstarch: an alternative to acute normovolemic hemodilution? Anesth Analg. 1997;84:26–30.PubMedGoogle Scholar
  6. 6.
    Weiskopf RB. Mathematical analysis of isovolemic hemodilution indicates that it can decrease the need for allogeneic blood transfusion. Transfusion. 1995;35:37–41.PubMedCrossRefGoogle Scholar
  7. 7.
    van Iterson M, van der Waart FJM, Erdmann W, Trouwborst A. Systemic haemodynamics and oxygenation during haemodilution in children. Lancet. 1995;346:1127–1129.PubMedCrossRefGoogle Scholar
  8. 8.
    Sharrock NE, Mineo R, Urquhart B, Salvati EA. The effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty. Anesth Analg. 1993;76:580–584.PubMedGoogle Scholar
  9. 9.
    Sharrock NE, Salvati EA. Hypotensive epidural anesthesia for total hip arthroplasty. Acta Orthop Scand. 1996;67: 91–107.PubMedCrossRefGoogle Scholar
  10. 10.
    Sharrock NE, Mineo R, Go G. The effect of cardiac output on intraoperative blood loss during total hip arthroplasty. Reg Anaesth. 1993;18:24–29.Google Scholar
  11. 11.
    Van Aken H, Miller ED Jr. Deliberate hypotension. In: Miller RD, ed. Anesthesia. New York, NY: Churchill Livingstone; 1994:1481–1503.Google Scholar
  12. 12.
    Sculco TP, Ranawat C. The use of spinal anesthesia for total hip replacement arthroplasty. J Bone Joint Surg Am. 1975;57:173–177.PubMedGoogle Scholar
  13. 13.
    Modig J. Beneficial effects on intraoperative and postoperative blood loss in total hip replacement when performed under lumbar epidural anesthesia: an explanatory study. Acta Chir Scand Suppl. 1988;550:95–103.Google Scholar
  14. 14.
    Modig J. Regional anaesthesia and blood loss. Acta Anaesthesiol Scand Suppl. 1988;32:44–48.CrossRefGoogle Scholar
  15. 15.
    Keith I. Anaesthesia and blood loss in total hip replacement. Anaesthesia. 1977;32:444–450.PubMedCrossRefGoogle Scholar
  16. 16.
    Sharrock NE, Mineo R, Urquhart B. Haemodynamic effects and outcome analysis of hypotensive extradural anaesthesia in controlled hypertensive patients undergoing total hip arthroplasty. Br J Anaesth. 1991;67:17–25.PubMedCrossRefGoogle Scholar
  17. 17.
    Sharrock NE, Cazan MG, Hargett MJ, Williams-Russo P, Wilson PD Jr. Changes in mortality after total hip and knee arthroplasty over a ten-year period. Anesth Analg. 1995; 80:242–248.PubMedGoogle Scholar
  18. 18.
    Sharrock NE, Ranawat CS, Urquhart B, Peterson M. Factors influencing deep vein thrombosis following total hip arthroplasty. Anesth Analg. 1993;76:765–771.PubMedGoogle Scholar
  19. 19.
    Thompson GE, Miller RD, Stevens WC, Murray WR. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology. 1978;48:91–96.PubMedCrossRefGoogle Scholar
  20. 20.
    Vazeery AK, Lunde O. Controlled hypotension in hip joint surgery: an assessment of surgical haemorrhage during sodium nitroprusside infusion. Acta Orthop Scand. 1979; 50:433–441.PubMedCrossRefGoogle Scholar
  21. 21.
    Rosberg B, Fredin H, Gustafson C. Anesthetic techniques and surgical blood loss in total hip arthroplasty. Acta Anaesthesiol Scand. 1982;26:189–193.PubMedCrossRefGoogle Scholar
  22. 22.
    Lieberman JR, Huo MM, Hanway J, Salvati EA, Sculco TP, Sharrock NE. The prevalence of deep venous thrombosis after total hip arthroplasty with hypotensive epidural anesthesia. J Bone Joint Surg Am. 1994;76:341–348.PubMedGoogle Scholar
  23. 23.
    Bading B, Blank S, Sculco TP, Pickering TG, Sharrock NE. Augmentation of calf blood flow by epinephrine infusion during lumbar epidural anesthesia. Anesth Analg. 1994;78: 1119–1124.PubMedCrossRefGoogle Scholar
  24. 24.
    Ranawat CS, Beaver WB, Sharrock NE, Maynard MJ, Urquhart B, Schneider R. Effect of hypotensive epidural anaesthesia on acetabular cement-bone fixation in total hip arthroplasty. J Bone Joint Surg Br. 1991;73:779–782.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Nigel E. Sharrock

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