Deliberate hypotension for orthopaedic surgery

Jiang, Jia; Yue, Yun; Li, Bo; Zhou, Ran

doi:10.1002/14651858.cd012096

Cited by 3 publications

(3 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hypertension has been known to cause increased blood loss due to increased pressure and velocity of blood flow through the blood vessels, leading to the development of techniques to combat perioperative hypertension. 60 Deliberate hypotensive techniques intraoperatively are common in orthopaedic procedures to help reduce blood loss. 61 Mean arterial blood pressure goals for patients without hypertension undergoing orthopaedic surgery are targeted for 50 to 65 mm Hg, while hypertensive patients can only afford a 30% reduction in mean arterial pressure due to concern for compromised end organ perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…61 Mean arterial blood pressure goals for patients without hypertension undergoing orthopaedic surgery are targeted for 50 to 65 mm Hg, while hypertensive patients can only afford a 30% reduction in mean arterial pressure due to concern for compromised end organ perfusion. 60 Furthermore, uncontrolled hypertension is a well-known contraindication for deliberate hypotensive techniques due to concern for end organ dysfunction. 62 It is plausible that hypertensive patients cannot afford larger reductions in blood pressure intraoperatively and thus experience greater blood loss during the procedure, predisposing them to increased blood transfusion requirements.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

Lee

Fassihi

et al. 2020

The Journal of Hip Surgery

View full text Add to dashboard Cite

Revision total hip arthroplasty (rTHA) is associated with significant intraoperative blood loss requiring transfusion. Given that blood transfusions increase the risk of numerous complications, efforts should be made to determine which patients are at high risk of transfusion and optimize them appropriately. This study aimed to identify independent risk factors associated with blood transfusion in patients undergoing rTHA for mechanical failure. A multi-institutional surgical registry was queried for all patients who underwent rTHA for mechanical failure from 2005 to 2016. Patients were divided into transfused and nontransfused cohorts and underwent univariate analysis for differences in demographic features, preoperative comorbidities, and operative variables. Multivariate regression models were generated to elucidate independent risk factors associated with perioperative blood transfusions. A total of 8,469 rTHA patients met inclusion and exclusion criteria, of which 1,863 (22.0%) received blood transfusions within 72 hours postoperatively. On multivariate logistic regression analysis, age ≥ 65 years (odds ratio [OR] 1.313; p < 0.001), female gender (OR 1.465; p < 0.001), insulin-dependent diabetes mellitus (OR 1.503; p = 0.003), chronic obstructive pulmonary disease (COPD; OR 1.307; p = 0.030), hypertension (OR 1.359; p < 0.001), hematologic disorders (OR 1.565; p < 0.001), preoperative blood transfusions (OR 3.851; p < 0.001), systemic sepsis (OR 2.277; p = 0.003), functional dependence (OR 1.416; p = 0.003), open wounds/wound infections (OR 2.878; p < 0.001), and operations lasting at least 175 minutes (OR 4.841; p < 0.001) were all significant independent risk factors for blood transfusions. Obesity (body mass index [BMI] ≥ 30 kg/m2; OR 0.818; p = 0.001), smoking history (OR 0.800; p = 0.014), and isolated acetabular component revision (OR 0.730; p < 0.001) were associated with a decreased risk of blood transfusion. Older age, female gender, lower BMI, absence of smoking history, functional dependence, insulin-dependent diabetes mellitus, hypertension, revision of the femoral component, preoperative transfusion, hematologic disorders, sepsis, open wounds/wound infections, COPD, and longer operative time were all independent risk factors for blood transfusions in rTHA performed for mechanical failure. By identifying these risk factors, clinicians can identify and optimize high-risk patients to minimize blood transfusion requirements, thereby reducing the risk of transfusion-associated complications in this patient population.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

Lee

Fassihi

et al. 2020

The Journal of Hip Surgery

View full text Add to dashboard Cite

show abstract

“…17 Although air tourniquet usage has been shown to be an effective and reliable strategy to slow blood loss during TKA, there have been reports of increased perioperative total blood loss and increased perioperative complication rates (nerve injury, deep vein thrombosis, delayed wound healing/ infection, compartment syndrome) after its utilization. 9,[18][19][20][21] Hypotensive anesthesia can also be an effective means of minimizing blood loss during TKA, 22 but the technique is challenging, dependent on the expertise of the surgical staff, and not appropriate for large subpopulations of patients. 23 Cell salvage techniques (where the patient's own blood is collected during the surgery, filtered for contaminants, an anticoagulant is added, and returned to the patient) are successful at mitigating many of the risks that accompany traditional allogenic transfusions, but are exceptionally costly and can be wasteful if the salvaged blood is not needed.…”

mentioning

confidence: 99%

Clinical Outcomes and Experience of a Multiyear Consecutive Case Series of Total Knee Arthroplasty Procedures Conducted with a Bipolar Sealer System for Hemostasis

Sah

2021

J Knee Surg

View full text Add to dashboard Cite

Maximizing hemostasis during total knee replacement procedures remains a key challenge in current practice. Bipolar sealer technology achieves intraoperative hemostasis through tissue sealing and coagulation with adjustable radio frequency energy and a saline-irrigated tip. Optimal surgical site hemostasis is important to avoid potential complications such as hemarthrosis, wound drainage, increased pain, delayed discharge, and readmissions. The aim of this study is to evaluate the safety and effectiveness of the bipolar sealer device in primary knee replacement in the largest consecutive series to date. A consecutive, treatment-control series of subjects who underwent a primary total knee arthroplasty (TKA) utilizing a bipolar sealer for hemostasis, one subgroup with concomitant tranexamic acid (TXA) administration (n = 1599) and one subgroup without TXA administration (n = 3582), compared with a control group of primary TKA under tourniquet only (n = 667). Statistical analyses were performed through two-tailed unpaired t-tests. There was less total postoperative drain output and a lower overall transfusion rate in the bipolar sealer group (807ml ± 428) (2.5%) than the tourniquet only group (1290 ± 658, p = 0.001) (8.4%, p = 0.0001), respectively. Drainage output in bipolar sealer + TXA (450 ± 297 ml) was lower than the other two groups (bipolar sealer 807 ± 428 mL, p = 0.0001; tourniquet only 1290 ± 658 ml, p = 0.0001). The bipolar sealer group had a higher hematocrit at postoperative day 1 (POD1) (bipolar sealer: 33.1 ± 4.3 cc, tourniquet only: 32.5 ± 4.3 cc, p = 0.001) and at discharge (POD2, bipolar sealer: 31.5 ± 3.7 cc, tourniquet only: 30.2 ± 3.9 cc, p = 0.0001). There were zero reported serious adverse events related to hemostasis management in any group. The bipolar sealer system is a safe and effective instrument to achieve intraoperative hemostasis during primary TKA. The bipolar sealer group required significantly fewer postoperative blood product transfusions and maintained a higher hematocrit concentration at the time of discharge compared with subjects treated solely with tourniquet mediated hemostasis. Addition of TXA to local hemostasis methods may further reduce blood loss and transfusion requirements. Level of Evidence This is a Level III study.

show abstract

Permissive hypotensive resuscitation in patients with traumatic hemorrhagic shock

Tarng

Chou

et al. 2019

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

We read the article “Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis” by Natthida Owattanapanich et al. with great interest and found it to be insightful. In our commentary, we propose possible reasons why mortality was lower in the permissive hypotension group and how the need for blood transfusion decreased in this group. No significant difference in acute kidney injury (AKI) was evident among patient groups, possibly because all these patients might have AKI. However, we do agree that permissive hypotension is of considerable benefit to trauma patients and worth further study.

show abstract

Deliberate hypotension for orthopaedic surgery

Cited by 3 publications

References 39 publications

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

Clinical Outcomes and Experience of a Multiyear Consecutive Case Series of Total Knee Arthroplasty Procedures Conducted with a Bipolar Sealer System for Hemostasis

Permissive hypotensive resuscitation in patients with traumatic hemorrhagic shock

Contact Info

Product

Resources

About