PROSTAGLANDIN-E(1) AS A HYPOTENSIVE DRUG DURING GENERAL-ANESTHESIA FOR TOTAL HIP-REPLACEMENT

Study Objective: To determine the effect of intravenous administration of prostaglandin E1 (PGE1) in inducing controlled hypotension during general anesthesia. Design: Randomized, prospective study. Setting: In patient surgery at a university hospital. Patients: 57 ASA physical st atus I and II patients scheduled for total hip replacement. Interventi ons: In 29 patients undergoing total hip replacement, PGE1 (0.11 +/- 0 .03 mug/kg/min) was infused to induce hypotension during general anest hesia with enflurane, isoflurane, or sevoflurane in nitrous oxide and oxygen. In another 28 patients, the control group, normotensive anesth esia was performed for the same procedure. Measurements and Main Resul ts: Systolic blood pressure decreased significantly (p < 0.01) from 13 6 +/- 22 mmHg to 93 +/- 10 mmHg during PGE1 infusion, although heart r ate did not change significantly. Arterial hemoglobin oxygen saturatio n showed a mild but significant decrease (p < 0.05) during PGE1 infusi on. Blood loss (480 +/- 132 ml) and blood transfusion (280 +/- 260 ml) during surgery were significantly less in patients with hypotensive a nesthesia (p < 0.01 and p < 0.05, respectively) than in patients with normotensive anesthesia (667 +/- 326 ml and 468 +/- 395 ml, respective ly). Blood loss and blood transfusion after surgery were similar in bo th groups. In the recovery room or surgical ward, 3 of 29 patients wit h hypotensive anesthesia needed rapid blood transfusion because of mod erate hypotension. The volume of urine during surgery was significantl y less (p < 0.05) in the control group. Two patients developed mild ph lebitis at the site of the PGE1 infusion, but there were no serious si de effects. Conclusion: These data suggest that PGE1 can be used safel y to induce hypotension, thereby reducing blood loss during total hip replacement with general anesthesia.