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Canadian Journal of Anesthesia 54:799-810 (2007)
© Canadian Anesthesiologists' Society, 2007
Reports of Original Investigations

Deliberate hypotension in orthopedic surgery reduces blood loss and transfusion requirements: a meta-analysis of randomized controlled trials

[L’hypotension délibérée en chirurgie orthopédique réduit les pertes sanguines et l’incidence transfusionnelle: une méta-analyse d’études randomisées contrôlées]

James Edward Paul, MD MSc FRCPC, Elizabeth Ling, MD MSc FRCPC, Carlos Lalonde, MD and Lehana Thabane, PhD

From the Department of Anesthesia, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Address correspondence to: Dr. James E. Paul, Assistant Clinical Professor, McMaster University, Department of Anesthesia, Hamilton Health Sciences, Hamilton General Site, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada. Phone: 905-527-0271, ext 46698; Fax: 905-577-8023; E-mail: james_paul{at}sympatico.ca

Purpose: To determine if deliberate hypotension decreases blood loss and transfusion requirements in patients undergoing orthopedic surgery, a systematic review of all randomized trials addressing this issue was undertaken.

Methods: Electronic databases, citations lists and review articles were searched for potential articles. Relevant articles met the following inclusion criteria: English language, humans undergoing orthopedic surgery, deliberate hypotension used by any method, intraoperative blood loss measured as an outcome, and the trial methodology being randomized and controlled. Four outcomes were analyzed, including estimated blood loss, blood transfused, surgery duration, and quality of the surgical field. For all analyses, the random-effects model was used.

Results: Seventeen articles met the inclusion criteria. The surgeries studied included total hip arthroplasty (seven), orthognathic surgery (eight), total knee arthroplasty (one) and spinal fusion (one). A total of 636 patients were randomized across all studies. For blood loss, the overall weighted mean difference favoured treatment, with a savings of about 287 mL of blood [95% confidence interval (CI): –447, –127]. The mean differences also showed a statistically significant benefit for deliberate hypotension in reducing transfusion requirements (–667 mL of blood transfused; 95% CI: –963, –370). Deliberate hypotension was not shown to reduce the duration of surgery (–1.9 min of surgery; 95% CI: –7.2, 3.5) or improve surgical conditions (surgical field quality rating –0.5; 95% CI: –1.1, 0.2).

Conclusion: This review provides some support for the use of deliberate hypotension in reducing blood loss and transfusion requirements in orthopedic surgery, but these results are tempered by the small sample sizes and poor methodological quality of published studies.






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