Abstract
Purpose
Radical prostatectomy is associated with substantial blood loss frequently requiring allogeneic blood transfusion. We investigated the efficacy of deliberate hypotension using combined epidural/general anesthesia in reducing allogeneic transfusion requirements in patients undergoing radical prostatectomy.
Methods
In a prospective, randomized, single-blind trial, 102 patients undergoing radical prostatectomy were allocated to either an epidural group (n = 51 ) or a control group (n = 51). In the epidural group, deliberate hypotension was achieved with a target mean arterial pressure of 55–60 mmHg. The trigger for allogeneic blood transfusion in both groups was a hematocrit value < 0.25.
Results
Operative blood loss in the epidural group was significantly less than that in the control group (955 ± 517 mL vs 1477 ± 823 mL respectively,P < 0.001). The percentage of patients who reached the threshold trigger for allogenic transfusion was significantly less in the epidural group (8% vs 26%, respectively,P = 0.019) and the number of patients who were actually transfused during hospitalization was also significantly less (P = 0.028). There were no serious adverse events in either group during the study.
Conclusion
Controlled hypotension using a combined epidural/general anesthetic technique is associated with significantly less blood loss, and a reduction in the use of allogeneic blood in patients undergoing radical prostatectomy compared to general anesthesia alone.
Résumé
Objectif
La prostatectomie radicale est associée à une perte sanguine importante qui nécessite des transfusions allogéniques. Nous avons vérifié l’efficacité d’une hypotension contrôlée pendant l’anesthésie péridurale et générale combinée pour réduire la nécessité de transfusion allogénique chez les patients qui subissent une prostatectomie radicale.
Méthode
Dans une étude prospective, randomisée et à simple insu, 102 patients devant subir une prostatectomie radicale ont été dirigés vers le groupe de péridurale (n =51) ou le groupe témoin (n = 51). Avec la péridurale, une hypotension contrôlée a été réalisée avec une tension artérielle moyenne cible de 55–60 mmHg. Un hématocrite < 0,25 était le seuil pour l’administration d’une transfusion sanguine allogénique.
Résultats
La perte sanguine opératoire a été significativement moindre dans le groupe de péridurale que dans le groupe témoin (955 ±517mLvs 1477 ± 823 mL,P < 0,001). Le pourcentage de patients chez qui l’hématocrite seuil a déclenché la transfusion a été significativement moindre avec la péridurale (8 % vs 26 %, respectivement,P = 0,019) et le nombre de patients transfusés pendant l’hospitalisation a aussi été significativement moindre (P = 0,028). Aucun événement indésirable grave n’a été relevé pendant l’étude.
Conclusion
L’hypotension contrôlée pendant une anesthésie péridurale et générale combinée, comparée à l’anesthésie générale seule, est associée à une perte sanguine significativement plus faible et à une réduction de transfusion allogénique chez des patients qui subissent une prostatectomie radicale.
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O’Connor, P.J., Hanson, J. & Finucane, B.T. Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery. Can J Anesth 53, 873–880 (2006). https://doi.org/10.1007/BF03022829
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DOI: https://doi.org/10.1007/BF03022829