British Journal of Anaesthesia, Vol 82, Issue 2 170-174, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
J. Boldt, A. Weber, K. Mailer, M. Papsdorf and P. Schuster
Blood loss in patients undergoing radical prostatectomy may be substantial.
In a randomized, prospective study, we assessed two methods of reducing the
need for allogeneic blood transfusion with regard to efficacy and costs.
Sixty patients undergoing retropubic radical prostatectomy were allocated
randomly to one of three groups. In group 1 (n = 20), acute normovolaemic
haemodilution (ANH) was initiated after induction of anaesthesia;
autologous blood 15 ml kg-1 was withdrawn and replaced by colloid solutions
(gelatin) to maintain haemodynamic stability. In group 2 (n = 20),
controlled hypotension was established using sodium nitroprusside (target
mean arterial pressure (MAP) approximately 50 mm Hg). Group 3 (n = 20),
without manipulations, served as a control group. Troponin T (TnT), a
sensitive marker for myocardial ischaemia, and various coagulation
variables were measured in the perioperative period. Packed red blood cells
(PRBC) were given when haemoglobin concentration was less than 7 g dl-1.
Cost calculations did not include hospital overhead costs or staff costs.
In the ANH group, mean 1278 (SD 150) ml of autologous blood were withdrawn.
Significantly more volume was infused in the ANH patients (gelatin 2450
(550) ml) than in the two other groups. Coagulation data (platelet count,
activated partial thromboplastin time (aPTT), fibrinogen, antithrombin III
(AT III), D-dimers) did not differ significantly between the three groups.
The hypotension group had significantly lower blood loss (1260 (570) ml),
whereas the ANH (1820 (680) ml) and control group (1920 (590) ml) did not
differ significantly. Patients in the hypotension group needed
significantly less PRBC (total 14 units; 75% of patients did not need PRBC)
than the ANH (total 21 units; 55% of patients did not need PRBC) or control
patients (total 28 units; 40% of patients did not need PRBC). Total costs
were lowest in the hypotension group (41% less than in the control
patients) (P < 0.05). We conclude that the use of hypotension during
radical prostatectomy resulted in approximately 40% reduction in total
transfusion costs. ANH was less effective and more costly than controlled
hypotension.
CLINICAL INVESTIGATIONS
Acute normovolaemic haemodilution vs controlled hypotension for reducing the use of allogeneic blood in patients undergoing radical prostatectomy
Department of Anaesthesiology and Intensive Care Medicine and the Clinic of Urology, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany
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