HYPOTENSIVE EPIDURAL-ANESTHESIA FOR TOTAL HIP-ARTHROPLASTY - A REVIEW

Hypotensive epidural anesthesia provides arterial hypotension to maint ain a mean arterial pressure of 50 mmHg and it can be used to reduce b lood loss during total hip replacement. The technique combines an exte nsive epidural blockade with an intravenous infusion of low-dose epine phrine. This results in arterial hypotension, but with preservation of central venous pressure, heart rate, stroke volume, cardiac output, a nd an augmentation of blood Row to the lower extremity. The technique does not appear to adversely affect cardiac, renal, or cerebral functi on and is used safely in patients with hypertension, ischemic heart di sease, and in the elderly. Intraoperative blood losses during primary total hip replacement are between 100 and 300 mt. Perioperative transf usions have declined with the introduction of the technique. Radiologi cal evidence of improved fixation of cemented acetabular components ha s been observed. Rates of deep-vein thrombosis are low: 2-3% proximal deep-vein thrombosis with an overall rate of 10%. In-hospital mortalit y is 0.1%; lower than previously published rates. In conclusion, hypot ensive epidural anesthesia is safe and provides a number of advantages over conventional anesthetic techniques for total hip replacement.