Canadian Journal of Anesthesia

, Volume 53, Issue 9, pp 873–880 | Cite as

Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery

  • Paul J. O’Connor
  • John Hanson
  • Brendan T. Finucane
General Anesthesia

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.

L’hypotension contr#x00F4;lée, pendant l#x2019;anesthésie péridurale et générale combinée pour la prostatectomie radicale, réduit la nécessité de transfusion

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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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Paul J. O’Connor
    • 1
  • John Hanson
    • 2
  • Brendan T. Finucane
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineUniversity of Alberta, Clinical Sciences BuildingEdmontonCanada
  2. 2.Division of Health, Population and InformationCross Cancer InstituteEdmontonCanada

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