Controlled Hypotensive Anesthesia to Reduce Blood Loss in Radical Cystectomy for Bladder Cancer

Abstract

Controlled intraoperative hypotension has been reported to reduce blood loss in major cancer operations. The effects of induced controlled hypotensive anesthesia using enflurane or trimethaphan compared to standard normotensive anesthesia were evaluated retrospectively in 37 consecutive patients who were undergoing single stage radical cystectomy with pelvic lymphadenectomy and bilateral ureteroileal cutaneous urinary diversion. Group 1 contained 16 patients who received induced hypotensive anesthesia, and group 2 contained 21 patients who received normotensive anesthesia. Average age, pathological stage and hematocrit values preoperatively and 5 days postoperatively were not significantly different. The average blood loss in group 1 was 821 .+-. 78 cm3 and in group 2 it was 1740 .+-. 132 cm3, a difference in 919 cm3 (P < 0.001). Concomitantly, total blood replacement was significantly different. The hypotensive group required an average of 1.38 .+-. 0.25 U or 700 .+-. 100 cm3 and the normotensive gorup averaged 3.25 .+-. 0.45 U or 1600 .+-. 225 cm3 (P < 0.05). Only 69% of the hypotensive group required blood replacement compared to 90% of the normotensive group. Controlled hypotensive anesthesia markedly reduces blood loss for radical bladder cancer surgery.