CORR Insights^®: Hypotensive Epidural Anesthesia Reduces Blood Loss in Pelvic and Sacral Bone Tumor Resections

Excerpt

Intraoperative hypotensive epidural anesthesia, when administered by those very familiar with the technique, is thought to be safe for hip surgery and may reduce bleeding and transfusion, improve the quality of the operative field, and shorten operative times [3]. However, intraoperative hypotension has also been associated with adverse events. A practice advisory regarding neuraxial anesthesia (from the American Society of Regional Anesthesia) recommends maintaining the blood pressure within 20% to 30% of baseline [2]. Recent observational studies suggest that brief exposure to intraoperative hypotension may double or triple 30-day mortality [1], acute kidney injury [4], and myocardial injury [5]. This information is hard to reconcile with intentional intraoperative hypotension, since the blood pressures associated with injury are commonly experienced by patients during hypotensive epidural anesthesia, without apparent harm. …