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

[L’hypotension contrôlée, pendant l’anesthésie péridurale et générale combinée pour la prostatectomie radicale, réduit la nécessité de transfusion]

Paul J. O’Connor, MB BCh FFARCSI^*, John Hanson, MSc and Brendan T. Finucane, MD FRCPC FRCA^*

^* From the Department of Anesthesiology and Pain Medicine, University of Alberta; and the
Division of Health, Population and Information, Cross Cancer Institute, Edmonton, Alberta, Canada.

Address correspondence to: Dr. Brendan T. Finucane, Department of Anesthesiology and Pain Medicine, University of Alberta, Clinical Sciences Building, Room 8-120, Edmonton, Alberta T6G 2B7, Canada. Phone: 780-407-2876; Fax: 780-407-7461. E-mail: bfinucan{at}ualberta.ca

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.

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