The effect of milrinone on induced hypotension in elderly patients during spinal surgery: a randomized controlled trial

Burden of disease of reoperations in instrumental spinal surgeries in Germany

“…Furthermore, spinerelated diseases such as spondylolisthesis, scoliosis, kyphosis, or spinal stenosis, are possible indications for ISS [1]. Due to the variety of indications, patients with the need for instrumental spinal surgeries are very heterogeneous and may vary from small children to frail elderly people [2][3][4][5][6][7][8].…”

Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials

“…Twenty-four comparisons in 20 studies compared the deliberate hypotension versus control (no deliberate hypotension) [42–44, 49, 51–53, 55–61, 63–65, 68–70]; four comparisons in three studies compared deliberate hypotension combined with acute normovolemic hemodilution versus acute normovolemic hemodilution [40, 45, 47]; seven comparisons in seven studies compared deliberate hypotension combined with acute hypervolemic hemodilution versus acute hypervolemic hemodilution [41, 48, 53, 62, 64, 66, 67]; two studies compared deliberate hypotension combined with acute hypervolemic hemodilution and cell salvage versus acute hypervolemic hemodilution combined with cell salvage [46, 50]; one study compared deliberate hypotension combined with cell salvage versus cell salvage [54]. Most of the included studies enrolled patients aged 17 to 65 years; four included elderly patients [43, 54–56], and seven studies included both adult and elderly patients [44, 46, 49, 50, 52, 58, 62]; four studies did not clearly describe this issue [60, 61, 63, 68]. The types of surgeries included spine surgery, total hip arthroplasty, pelvic surgery, or femoral fracture surgery.…”

“…The types of surgeries were not clarified in four studies [41, 42, 45, 53]. Eight methods of deliberate hypotension were investigated: remifentanil [40–42, 45, 59, 66], nitrates [43, 45, 48, 50, 51, 53, 55, 59, 61–64], sevoflurane [46, 54], esmolol [47], milrinone [49], epidural anesthesia [58], nicardipine [60, 68, 70], and a combination of two or three hypotensive drugs [44, 52, 56, 57, 61, 65, 67, 69, 70]. The controlled MAP level in 14 studies was ≥ 60 mmHg [40, 43, 50, 54, 56, 57, 60–62, 64, 66, 68–70]; seven studies only limited the percentage of hypotension [44, 45, 51–53, 63, 67]; one study controlled the MAP between 45 and 50 mmHg; other studies covered two or more hypotensive level groups.…”

“…Fourteen studies did not provide the transfusion trigger points [41, 43, 44, 46, 50, 52, 55–57, 60, 63, 65, 68, 69]. Thirteen studies described the method of measuring the volume of blood loss; most of which was defined as “blood collected in the suction bottles and the increased weight of gauzes” [41, 42, 46, 48, 49, 51, 53, 57, 58, 60, 63, 64, 67]. The characteristics of the included studies was summarized in Table 1.…”

“…2 and Additional file 2: Table S3. All included studies except one [49] were classified as unclear or high risk study. The evidence for most of the outcomes was graded as low-quality for imprecision due to very small sample size or for inconsistency due to high level of heterogeneity (Additional file 2: Table S4).…”