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ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 4  |  Page : 1238-1243

Hypotensive epidural anesthesia in patients with preoperative renal dysfunction presenting for hip arthroplasty


Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Tanta, Egypt

Correspondence Address:
Ahmed S El-Gebaly
Department of Anesthesia and ICU, Faculty of Medicine, Tanta University, Tanta 31511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_137_17

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Objective To investigate the benefits and safety of hypotensive epidural anesthesia (HEA) in comparison with normotensive epidural anesthesia in patients with preoperative renal dysfunction presenting for hip arthroplasty. Background HEA is one of the anesthetic techniques used to reduce perioperative blood loss for total hip replacement. The technique includes a combination of an extensive epidural block and an intravenous infusion of low-dose epinephrine (1–5 μg/min) to adjust and control the mean arterial blood pressure together with preserving central venous pressure and cardiac output. Patients and methods Forty adult patients of both sexes undergoing primary unilateral hip arthroplasty, ranging in age from 60 to 74 years, ASA II–III with mild renal dysfunction were divided into two groups: group I received epidural anesthesia with strict preservation of the mean arterial blood pressure (65–90 mmHg) during surgery using vasopressors, fluids, and/or blood transfusions and group II received epidural anesthesia and hypotension was induced by maintaining the mean arterial blood pressure at 55–60 mmHg during the entire surgery. Results The heart rate and the mean arterial blood pressure showed a significant difference between the two groups at 15, 30, 45, 60, and 90 min intraoperatively (P < 0.05). Serum creatinine was significantly increased in group II at 6 h (P < 0.05) and postoperatively, with a significant decrease in creatinine clearance in group II at 24 h postoperatively (P < 0.05). The mean values of blood urea showed a significant increase in group II than group I after 6, 12, 24, and 48 h postoperatively. The duration of surgery was significantly different between the groups; it was longer in group I than group II (P < 0.05). Blood loss and blood transfusion were significantly decreased (P < 0.05) in group II than group I. The mean epinephrine infusion rate was significantly increased in group I (P < 0.05). Hematocrit was significantly decreased in both groups postoperatively (P < 0.05). Conclusion HEA is superior to normotensive epidural anesthesia in patients with renal impairment undergoing hip arthroplasty in the form of decreased blood loss and the need for blood infusion, provides a clear surgical field, and leads to an improvement in cement fixation and decreased incidence of postoperative deep vein thrombosis and blood loss, with no evidence of acute kidney injury postoperatively.


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