PREOPERATIVE ACUTE HYPERVOLEMIC HEMODILUTION WITH HYDROXYETHYLSTARCH - AN ALTERNATIVE TO ACUTE NORMOVOLEMIC HEMODILUTION

Acute normovolemic hemodilution (ANH) may help to reduce demand for ho mologous blood but requires extra time and apparatus. A more simple pr ocedure is acute hypervolemic hemodilution (HHD), where hydroxyethylst arch is administered preoperatively without removal of blood. In a pro spectively randomized study we compared ANH (preoperatively 15 mL/kg a utologous blood removal and replacement with 15 mL/kg of hydroxyethyls tarch with HHD (15 mL/kg of hydroxyethylstarch administered preoperati vely) in 49 patients undergoing hip arthroplasty. To avoid excessive i ntravascular volume, we used the vasodilating effect of isoflurane. No significant differences were found between groups (ANH, n = 23; HHD, n = 26) for intraoperative blood loss (ANH versus HHD, median [minimum -maximum]); 545 [295-785] mL versus 520 [315-825] mL) and postoperativ e blood loss (730 [525-945] mL versus 780 [495-895] mL), postoperative hemoglobin, hematocrit, platelet count or coagulation variables, and transfusion requirements (ANH 43% versus HHD 35% of patients received homologous blood) (P > 0.05). Heart rate did not change significantly in either group. In the ANH group mean arterial blood pressure (MAP) d ecreased after hemodilution (P < 0.05) while in the HHD group MAP did not change over time. Mean time required to preform ANH was 58 (46-62) min versus HHD 16 (12-19) min (P < 0.05). Costs for ANH were $63.60 U SD and for HHD $32.75 USD (labor costs not included). In orthopedic pa tients undergoing hip replacement with a predicted blood loss of about 1000 mL, HHD seems to be a simple as well as time- and cost-saving al ternative for ANH.