At the moment , the evidence available can not prove that neuraxial anesthesia is more effective and safer than general anesthesia for urological surgery .
There were insufficient data to pool the results relating to mortality , stroke , myocardial infa rct ion , length of hospitalization , quality of life , degree of satisfaction , postoperative cognitive dysfunction and blood transfusion requirements
CONTEXT AND OBJECTIVE Choosing the best anesthetic technique for urological surgery with the aim of mortality reduction remains controversial .
The objective here was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for urological surgery .
Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery
Purpose Radical prostatectomy is associated with substantial blood loss frequently requiring allogeneic blood transfusion . We investigated the efficacy of deliberate hypotension using combined epidural/general anesthesia in reducing allogeneic transfusion requirements in patients undergoing radical prostatectomy . Methods In a prospect i ve , r and omized , single-blind trial , 102 patients undergoing radical prostatectomy were allocated to either an epidural group ( n = 51 ) or a control group ( n = 51 ) . In the epidural group , deliberate hypotension was achieved with a target mean arterial pressure of 55–60 mmHg . The trigger for allogeneic blood transfusion in both groups was a hematocrit value < 0.25 . Results Operative blood loss in the epidural group was significantly less than that in the control group ( 955 ± 517 mL vs 1477 ± 823 mL respectively , P < 0.001 ) . The percentage of patients who reached the threshold trigger for allogenic transfusion was significantly less in the epidural group ( 8 % vs 26 % , respectively , P = 0.019 ) and the number of patients who were actually transfused during hospitalization was also significantly less ( P = 0.028 ) . There were no serious adverse events in either group during the study . Conclusion Controlled hypotension using a combined epidural/general anesthetic technique is associated with significantly less blood loss , and a reduction in the use of allogeneic blood in patients undergoing radical prostatectomy compared to general anesthesia alone . RésuméObjectifLa prostatectomie radicale est associée à une perte sanguine importante qui nécessite des transfusions allogéniques . Nous avons vérifié l’efficacité d’une hypotension contrôlée pendant l’anesthésie péridurale et générale combinée pour réduire la nécessité de transfusion allogénique chez les patients qui subissent une prostatectomie radicale . MéthodeDans une étude prospect i ve , r and omisée et à simple insu , 102 patients devant subir une prostatectomie radicale ont été dirigés vers le groupe de péridurale ( n = 51 ) ou le groupe témoin ( n = 51 ) . Avec la péridurale , une hypotension contrôlée a été réalisée avec une tension artérielle moyenne cible de 55–60 mmHg . Un hématocrite < 0,25 était le seuil pour l’administration d’une transfusion sanguine allogénique . RésultatsLa perte sanguine opératoire a été significativement moindre dans le groupe de péridurale que dans le groupe témoin ( 955 ±517mLvs 1477 ± 823 mL , P < 0,001 ) . Le pourcentage de patients chez qui l’hématocrite seuil a déclenché la transfusion a été significativement moindre avec la péridurale ( 8 % vs 26 % , respectivement , P = 0,019 ) et le nombre de patients transfusés pendant l’hospitalisation a aussi été significativement moindre ( P = 0,028 ) . Aucun événement indésirable grave n’a été relevé pendant l’étude . Conclusion L’hypotension contrôlée pendant une anesthésie péridurale et générale combinée , comparée à l’anesthésie générale seule , est associée à une perte sanguine significativement plus faible et à une réduction de transfusion allogénique chez des patients qui subissent une prostatectomie radicale
At the moment , the evidence available can not prove that neuraxial anesthesia is more effective and safer than general anesthesia for urological surgery .
There were insufficient data to pool the results relating to mortality , stroke , myocardial infa rct ion , length of hospitalization , quality of life , degree of satisfaction , postoperative cognitive dysfunction and blood transfusion requirements
CONTEXT AND OBJECTIVE Choosing the best anesthetic technique for urological surgery with the aim of mortality reduction remains controversial .
The objective here was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for urological surgery .