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

Study Objective: To assess the efficacy and safety of hemodilution com bined with induced hypotension during surgery. Design: Randomized, non blinded controlled study. Setting: Operating room suite and intensive care unit (ICU) at a university hospital. Patients: 16 ASA physical st atus I and II patients who underwent general or general plus epidural anesthesia for major orthopedic surgery. Interventions: 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 m g of 0.5% bupivacaine into the epidural catheter. Hematocrit was decre ased 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 u sed. Measurements and Main Results: Efficacy of hemodilution combined with induced hypotension (Group 1) was compared to standard management of blood volume and pressure (Group 2) by measuring transfusion volum e and length of ICU stay. Safety Of hemodilution/hypotension was deter mined by measuring the electroencephalogram, internal jugular venous o xygen saturation, the electrocardiogram, and central venous oxygen sat uration. In Group I, both the volume of homologous blood (225 +/- 150 ml) and total blood (1440 +/- 286 ml) was significantly less than the volume of homologous blood transfused in Group 2 (2650 +/- 875 ml). No patients in Group 1, but all patients in Group 2 required ICU admissi on (3.5 +/- 1.6 days) for treatment to prevent sequelae from, or progr ession of, moderate-severe tissue edema and metabolic acidosis. Cerebr al and myocardial measures were not significantly different between gr oups. Conclusions: Hemodilution combined with induced hypotension was safe and may reduce the need for transfusion and ICU admission. (C) 19 97 by Elsevier Science Inc.