Background
Methods
Eligibility criteria
Search strategy
Study selection
Data extraction and management
Assessment of risk of bias in included studies
Measures of treatment effect
Data synthesis
Subgroup analysis and investigation of heterogeneity
Sensitivity analysis
Results
Description of studies
Results of the search
Study ID | Locations | Sample sizes | Intervention groups | Comparison groups | Age range (years) | MAP levels (mmHg, DH group) | MAP levels (mmHg, C group) | Definitions of intraoperative blood loss | Types of surgeries | Anesthesia | Overall mortality | Occurrence of serious adverse events |
---|---|---|---|---|---|---|---|---|---|---|---|---|
An 2015 [40] | China | 60 | Remifentanil | DH + ANH vs. ANH | 37–64 | 60–70 | 70–80 | Not stated | Complicated orthopedic | GA | Y (24h post-op) | Y (24h post-op) |
Cheng 2003 [41] | China | 30 | Remifentanil | DH+AHH vs. AHH | 19–65 | 55–65 | 89 ± 9.1 | Increased weight of gauzes | Orthopedic | GA | N (24h post-op) | N (24h post-op) |
Chi 2005 [42] | China | 29 | Remifentanil | DH vs. C | 22–61 | 55–65; 65 ± 7 | 90 ± 10 | Blood collected in suction bottles and increased weight of gauzes | Orthopedic (spine or joint) | GA | N (> 1 h post-op) | N (> 1 h post-op) |
Diao 2006 [43] | China | 40 | Nitrates | DH vs. C | 71–79 | 70% of baseline; no less than 60 | Not stated | Not stated | THA | GA | N (4 days post-op) | N ( days post-op) |
Dong 2012 [44] | China | 54 | Drug combination | DH vs. C | 44–78 | 70% of baseline | 86 ± 8 | Not stated | THA | GA | N (4 days post-op) | N (4 days post-op) |
Fang 2011 [45] | China | 37 | Remifentanil | DH + ANH vs. ANH | 38–65 | 70% of baseline | ANH: 87 ± 4; C: 85 ± 6 | Not stated | Orthopedic | GA | N | N |
38 | Nitrates | DH + ANH vs. ANH | ||||||||||
Fukusaki 2008 [46] | Japan | 30 | Sevoflurane | DH + AHH+ A vs. AHH+ A | 51–70 | 55 | 95 | Weighing swabs and measuring blood collected from wound drainage. | THA | GA | N (7 days post-op) | Y (7 days post-op) |
Han 2006 [47] | Korea | 56 | Esmolol | DH + ANH vs. ANH | < 65 | 55–65 (57.3 ± 4.4) | 85.1 ± 5.7 | Not stated | Posterior lumbar fusion | GA | N (7 days post-op) | Y (1 week post-op) |
Hu 2005 [48] | China | 20 | Nitrates | DH + AHH vs. AHH | 38–65 | 55–65 | 70–100 | Increased weight of gauzes. | THA | SA + EA | N | N |
Hwang 2013 [49] | Korea | 40 | Milrinone | DH vs. C | 60–70 | ≤ 60 | Not stated | Blood in suction bottle and weighing the wet gauzes | Posterior lumbar fusion | GA | N | N |
Jin 2008 [50] | China | 60 | Nitrates | DH + AHH + A vs. AHH + A | 48–66 | 65 ± 5 | 86.7 ± 10.3 | Not stated | THA | GA | N (unclear) | Y (unclear) |
Kazemi 2006 [51] | Iran | 60 | Nitrates | DH vs. C | 20–60 | 85% of baseline | 94% of baseline (85–95) | Blood in suction container and degree of wetness of used sponges were estimated | Open fixation of femur fracture | GA | Y (unclear, during hospital stay) | Y (unclear, during hospital stay) |
Li 2012 [52] | China | 50 | Drug combination | DH vs. C | 51–86 | 70% of baseline | Not stated | Not stated | THA | EA+SA | N | N |
Liang 2004 [53] | China | 24 | Nitrates | DH + AHH vs. AHH | 41–63 | 70% of baselineDH + AHH: 61 ± 6; DH: 63 ± 4 | AHH: 89 ± 8; C: 95 ± 12 | Blood collected in suction bottles and estimated blood in gauzes | Orthopedic | GA | N (24 h post-op) | N (24 h post-op) |
24 | Nitrates | DH vs. C | ||||||||||
Liu 2009 [55] | China | 60 | Nitrates | DH vs. C | 65–82 | Decreased by 30% of baseline, and not less than 55 | 86 ± 16 | Not stated | THA | GA | N (4 days post-op) | N (4 days post-op) |
Liu 2011 [56] | China | 40 | Drug combination | DH vs. C | 65–82 | 70% baseline and no less than 60 | 88 ± 5 | Not stated | THA | GA | N (4 days post-op) | N (4 days post-op) |
Liu 2014 [54] | China | 60 | Sevoflurane | DH + A vs. A | 65–83 | 65–75 | 86.2 ± 8.6 | Not stated | Unilateral THA | GA | N (48 h post-op) | N (48 h post-op) |
Luo 2011 [57] | China | 60 | Drug combination | DH vs. C | 30–62 | 55.7 ± 6.9 | 85.3 ± 10.4 | Blood collected in suction bottles, blood loss of gauzes and salt water towel. | Spine surgery | GA | N | N |
Niemi 2000 [58] | Finland | 30 | Epidural anesthesia | DH vs. C | Not stated | 50–60 | Not stated | Contents of suction bottles and increase in weight of surgical swabs | Unilateral THA | EA in DH group and SA in C group | N (next morning of surgery) | N (next morning of surgery) |
Wang 2012 [59] | China | 23 | Remifentanil | DH vs. C | 50–65 | 70% of baseline (no less than 55): | 79 ± 12 | Not stated | THA | GA | N | N |
22 | Nitrates | DH vs. C | ||||||||||
Wu 2000 [60] | China | 20 | Nicadipine | DH vs. C | Not stated | 60–65 | 95 ± 4.6 | Blood collected in suction bottles and the increased weight of gauzes. | Intervertebral disc pick out and vertebra planted bone | GA | N (unclear) | Y (unclear) |
Xiao 2005 [61] | China | 37 | Nitrates | DH vs. C | Not stated | 60–65 | Not stated | Not stated | Internal fixation of vertebral or pelvic fracture; spinal tumor resection | GA | N | N |
38 | drug combination | DH vs. C | ||||||||||
Xiong 2015 [62] | China | 40 | Nitrates | DH + AHH vs. AHH | 50–73 | 65 ± 5 | Not stated | Not stated | THA | GA | N | N |
Yang 2002 [63] | China | 50 | Nitrates | DH vs. C | Not stated | 60–70% of baseline | Not stated | Blood collected in suction bottles and the increased weight of gauzes. | Cervical posterior decompression | GA | N | N |
Yuan 2015 [64] | China | 40 | Nitrates | DH + AHH vs. AHH | 48–62 | 65 ± 5 | Not stated | Blood collected in suction bottles and increased weight of gauzes. | Internal fixation of thoracolumbar spine | GA | N | N |
40 | Nitrates | DH vs. C | ||||||||||
Zhai 2011 [65] | China | 30 | Drug combination | DH vs. C | 18–59 | 55–65 | Not stated | Not stated | Posterior lumbar decompression and bone grafting | GA | N (5 days post-op) | N (5 days post-op) |
30 | 45–50 | |||||||||||
Zhang 2009 [66] | China | 20 | Remifentanil | DH + AHH vs. AHH | 22–54 | 68 ± 5 | AHH: 83 ± 5; C: 86 ± 7 | Not stated | Fixation of vertebral pedicle | GA | N | N |
Zhu 2006 [68] | China | 40 | Nicadipine | DH vs. C | Not stated | 60–65 | Not stated | Not stated | THA; internal fixation of femoral fracture | GA + EA | N (2 days post-op) | N (2 days post-op) |
Zhu 2007 [67] | China | 24 | Drug combination | DH + AHH vs. AHH | 35–65 | 75% of baseline | AHH: 70–90; C: 70–100 | Blood collected in suction bottles and increased weight of gauzes | Spinal surgery | GA | N (1 day post-op) | N (1 day post-op) |
Zhu 2009 [69] | China | 60 | Drug combination | DH vs. C | 25–58 | 60–65 | Not stated | Not stated | THA; internal fixation of femoral fracture | GA | N (2 days post-op) | N (2 days post-op) |
Zhu 2013 [70] | China | 45 | Nicadipine | DH vs. C | 30–60 | 60–65 | Not stated | Not stated | THA, internal fixation of femoral fracture | GA | N (2 day post-op) | N (2 day post-op) |
45 | Drug combination |