Blood Pressure, Not Cardiac Output, Determines Blood Loss during Induced Hypotension

Sivarajan, Murali; Amory, David W.; Everett, Gaither B.; Buffington, Charles W.

doi:10.1097/00132586-198102000-00022

Cited by 18 publications

(12 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lee et al measured blood flow in the paraspinal muscles during spine surgery with 2 hypotensive drugs, reaching a similar degree of hypotension. They found widely differing values for local blood flow (25), although blood loss did not differ. This result indicates that the effect on local blood flow is not the only factor that is involved.…”

Section: Discussionmentioning

confidence: 95%

Effect of Clonidine Premedication on Blood Loss in Spine Surgery

et al. 2012

View full text Add to dashboard Cite

Background:Blood loss in spine surgery is an important issue, even though it has been understudied compared with hip and knee arthroplasty.Objectives:In this study, we evaluated the effect of oral clonidine as premedication on blood loss in lumbar spine fusion surgery under anesthesia with propofol and remifentanil.Patients and Methods:In this double-blind, randomized clinical trial, 30 patients who were undergoing lumbar spine posterior fusion surgery due to traumatic fracture were allocated randomly into 2 groups. The study group (clonidine group) received a 200-μg oral clonidine tablet 60–90 minutes before anesthesia, and the control group received placebo at the same time. Induction and maintenance of anesthesia and the mean target arterial pressure for controlled hypotension with remifentanil were the same in the 2 groups. We compared the amount of intraoperative blood loss, dose of remifentanil/hour administered, need for nitroglycerine to reach the mean target arterial pressure when remifentanil was insufficient, duration of operation, and surgeon’s satisfaction of a bloodless field between groups.Results:There was no statistically significant difference between groups in age (P = 0.115), sex (P = 0.439), weight (P = 0.899), operation time (P = 0.2), or American Society of Anesthesiologists physical status score (P = 0.390).Intraoperative blood loss and remifentanil dose administered per hour in the clonidine group were significantly less than in the control group (P = 0.002 and P = 0.001, respectively), but there was no significant difference in surgeon’s satisfaction between groups (P = 0.169).Conclusions:As an oral premedication, clonidine can reduce surgical blood loss in lumbar spine posterior fusion surgery, even at the same levels of mean arterial pressure (MAP) with the control group. Its use can be studied in more complicated spine surgeries, such as scoliosis and spinal deformity surgeries.

show abstract

Section: Discussionmentioning

confidence: 95%

Effect of Clonidine Premedication on Blood Loss in Spine Surgery

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Of previous studies evaluating the effect of MAP on quality of the surgical field, many found that lower pressures were advantageous in producing better surgical visibility and/or bleeding . However, the opposing view that bleeding and/or surgical visibility does not always correlate with intraoperative blood pressure is noted …”

Section: Discussionmentioning

confidence: 99%

“…Anesthetic techniques to minimize bleeding include: patient placement in the reverse Trendelenberg position, use of a laryngeal mask in lieu of an endotracheal tube, maintenance of normothermia or mild hypothermia, control of pulse rate below 60 beats per minute, application of total intravenous anesthesia (TIVA), and controlled hypotension …”

Section: Introductionmentioning

confidence: 99%

The relationship between hypotension, cerebral flow, and the surgical field during endoscopic sinus surgery

Renen

Ludbrook

et al. 2014

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…Greater blood loss also increases the requirement for blood transfusions, and several reports have suggested that allogeneic blood transfusions are a risk factor for postoperative bacterial infections [7,8]. It has been demonstrated that the amount of bleeding during surgery is strongly dependent on arterial BP [9]. Induced hypotension has long been used as an effective method for decreasing intraoperative blood loss during spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intraoperative blood loss during spinal surgery using either remifentanil or fentanyl as an adjuvant to general anesthesia

et al. 2013

View full text Add to dashboard Cite

BackgroundRemifentanil enhances intraoperative hemodynamic stability, suggesting that it may decrease intraoperative blood loss when included as an adjuvant to general anesthesia. This retrospective study compared intraoperative blood loss during spinal surgery in patients administered either remifentanil or fentanyl as an opioid adjuvant.MethodsWe reviewed clinical and surgical data from 64 consecutive laminoplasty or laminectomy patients treated at National Hospital Organization Zentsuji Hospital between April 2010 and March 2011. Patients received either remifentanil (n = 35) or fentanyl (n = 29) as an opioid analgesic during general anesthesia. In addition to intraoperative blood loss, indices of hemodynamic stability, including heart rate as well as systolic, mean, and diastolic blood pressure (BP), were compared over the entire perioperative period between remifentanil and fentanyl groups.ResultsThe remifentanil group exhibited significantly lower intraoperative arterial BP than the fentanyl group. Intraoperative blood loss was also significantly lower in the remifentanil group (125 ± 67 mL vs. 165 ± 82 mL, P = 0.035).ConclusionsIntraoperative blood loss during spinal surgery was decreased in patients who received remifentanil as an opioid adjuvant, possibly because of lower intraoperative BP. A larger-scale prospective randomized controlled trial is warranted to confirm our results and to test whether remifentanil can decrease intraoperative blood loss during other surgical procedures.

show abstract

Blood Pressure, Not Cardiac Output, Determines Blood Loss during Induced Hypotension

Cited by 18 publications

References 0 publications

Effect of Clonidine Premedication on Blood Loss in Spine Surgery

Effect of Clonidine Premedication on Blood Loss in Spine Surgery

The relationship between hypotension, cerebral flow, and the surgical field during endoscopic sinus surgery

Comparison of intraoperative blood loss during spinal surgery using either remifentanil or fentanyl as an adjuvant to general anesthesia

Contact Info

Product

Resources

About