Objective To determine the effects of controlled hypotension (CH) on cerebra1 blood flow, cerebra1metabolism, and cognitive functions. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to 2008), EMbase (1974 to 2008), The Cochrane Library (Issue 2, 2008), CBM (1978 to 2008), and CNKI (1994 to 2008). The quality of included trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by The Cochrane Collaboration was used for statistical analysis. Results Nine RCTs involving a total of 295 patients were included. Most of the studies were of poor methodological quality. Meta-analysis was performed because the outcomes were the comparisons of the means of several repeated measures, and so a descriptive analysis was conducted. There were no significant differences in cerebral blood flow velocity, hypoxia-induced metabolites, and cognitive function between the CH group and the control group (Plt;0.05). But the S100B protein level in cerebrospinal fluid or blood was significantly higher in the CH group than that in the control group (Plt;0.02). Conclusion CH has no adverse effects on cerebra1 blood flow, cerebra1 metabolism, or cognitive functions. But isoflurane-induced hypotension may increase the release of S100B, indicating worse brain injury. The above conclusions were made from the limited evidence, and more rigorous RCTs are needed.
ObjectiveTo observe the effect of acute normovolemic hemodilution (ANH) with autologous blood transfusion (ABT) and controlled hypotension (CH) during surgery on allogeneic blood transfusion and blood coagulation function. MethodsSixty patients in our hospital from February 2012 to January 2014 were chosen as our study subjects. They underwent surgeries of grade Ⅲ to Ⅳ, and the estimated amount of bleeding during surgery was more than 400 mL. The patients were randomized into group A (ANH+CH group) and group B (control group), with 30 in each. Patients in group A were first administered a standard endotracheal general anesthesia. Then an invasive arterial blood pressure monitoring was performed and the central venous blood was taken. ANH was implemented, and CH was applied to reduce bleeding. When the procedure was almost completed, ABT was implemented. The value of hematocrit, hemoglobin, platelet, prothrombin time (PT), activated partial thranboplastin time (APTT), fibrinogen, international normalized ratio (INR), heart rate, mean arterial pressure and central venous pressure were measured and recorded at the end of blood volume collection (T1), and before ABT (T2) and after ABT (T3). When hemoglobin was lower than 70 g/L during the surgery, ABT was implemented. After surgery, no allogeneic blood transfusion was performed if hemoglobin was higher than 90 g/L. Patients in group B received routine treatment. ResultsPatients' hemodynamics maintained relatively stable during ANH+ABT+CH. Blood volume collected from patients was (408.3 ±142.1) mL; blood loss volume was (705.4±586.8) mL. Compared with group B, the amount of bleeding was significantly lower, and it was reduced by (549.2±250.2) mL. No organ damage was found. For group A, compared with those values at T0, PT, hematocrit, hemoglobin, fibrinogen, and INR were significantly different at T1 and T2 (P<0.05), but the average value was within the acceptable range which did not affect the blood coagulation function. PT, APTT, platelet, hematocrit, hemoglobin, fibrinogen, and INR were significantly different before and after autologous blood transfusion (P<0.05). Postoperative infection and non-healing wounds rate was not significantly different between the two groups (P>0.05). ConclusionThis technique of acute normovolemic hemodilution with autologous blood transfusion and controlled hypotension is a useful, efficient and cost-effective blood conservation strategy. Moderate hemodilution has no influence on blood coagulation function in patients.
ObjectiveTo investigate the feasibility and clinical effect of controlled hypotension in 3 cm single-port video-assisted thoracoscopic surgery (VATS) for the lymph node group 7 dissection in the left lung resection. MethodsWe retrospectively analyzed the clinical data of 37 patients with lung cancer who underwent 3 cm single-port VATS from May 2015 to August 2015 in Tongji Hospital, and systolic blood pressure of 12 patients (7 males, 5 females, average age of 58.3 years, range 42-69 years) was controlled between 80-90 mm Hg by nitroglycerin or sodium nitroprusside while the pressure of 25 patients (14 males, 11 females, average age of 57.7 years, range 43-68 years) was not controlled when receiving lymph node group 7 dissection. ResultsControlled hypotension in lymphadenectomy achieved satisfactory results. The lymphadenectomy time of 12 patients with controlled hypotension (18.5±4.3 min on average, range 15.6-25.3 min) was shorter than that of 25 patients without controlled hypotension (24.3±5.1 min on average, range 18.2-29.8 min); the difference was statistically significant (P<0.05). ConclusionControlled hypotension is a simple and feasible method that increases the operating space, and reduces the difficulty of cleaning lymph nodes and the risk of bleeding.
ObjectiveTo evaluate the feasibility and clinical effect of controlled hypotension in video-assisted thoracoscopic surgery (VATS) for subcarinal lymph node dissection in patients with lung cancer.MethodsWe analyzed the clinical data of 53 non-small cell lung cancer (NSCLC) patients undergoing VATS with controlled systolic blood pressure while dissecting the subcarinal lymph node from September to October 2016 in our department (a treatment group, including 31 males and 22 females with an average age of 53.20±8.80 years ranging 43-68 years). We selected 112 NSCLC patients undergoing VATS without controlled systolic blood pressure while dissecting the subcarinal lymph node from January to August 2016 in our department (a contol group, including 67 males and 45 females with an average age of 54.32±7.81 years ranging 39-73 years). The clinical data of both groups were compared.ResultsThe operation time and blood loss of the treatment group were less than those of the control group (177.6±39.4 min vs. 194.3±47.8 min, 317.9±33.6 ml vs. 331.2±38.7 ml, P<0.05). The duration of subcarinal lymph node dissection and total duration of lymph node dissection of the treatment group were also less than those of the control group (10.5±4.3 min vs. 13.6±5.2 min, 37.7±7.5 min vs. 48.7±6.4 min, P<0.001). The thoracic drainage at postoperative days 1, 2, 3 and total drainage volume, duration of tube placement and hospital stay of the treatment group were less than those of the control group (P<0.05). Whereas the postoperative complications of the two groups did not differ significantly (P>0.05).ConclusionControlled hypotension reduces the difficulty of dissecting subcarinal lymph nodes and the risk of bleeding, and produces less drainage volume, which is safe and effective.
ObjectivesTo systematically review the efficacy and safety of controlled hypotension for total hip or knee replacement.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on controlled hypotension for total hip or knee replacement from inception to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 854 patients were included. The results of meta-analysis showed that compared with no controlled hypotension during surgery, controlled hypotension could reduce intraoperative blood loss (MD=−267.35, 95%CI −314.54 to −220.16, P<0.000 01), allogeneic blood transfusion (MD=−292.84, 95%CI −384.95 to −200.73, P<0.000 01), and 24 h postoperative mini-mental state examination (MMSE) score (MD=−1.08, 95%CI −1.82 to −0.34, P=0.004). However, there were no significant differences in 96 h postoperative MMSE score (MD=−0.11, 95%CI −0.50 to 0.28, P= 0.57) and intraoperative urine volume (MD=57.93, 95%CI −152.57 to 268.44, P=0.59).ConclusionsThe current evidence shows that controlled hypotension during total hip or knee replacement can reduce intraoperative blood loss and allogeneic blood transfusion. Furthermore, there is no obvious effect on the maintenance of blood perfusion in important organs, despite certain effects on the postoperative cognitive function, which can be recovered in short term. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.