Deliberate hypotension-what is for and

what is against using it?

Gabriel M. Gurman

The idea behind the concept of using deliberate hypotension (DH) as part
of anesthesia for surgery derives from the fear of blood transfusion, a replacement accompanied by well known risks and complications.
But beside this, we all know that the surgeon expects to have a bloodless
field when he is operating, especially for those procedures in which he/she
expects significant blood loss.
So the main purposes of DH are a decrease in surgical blood loss and a
better exposure and improved visibility of the surgical field. As an addition,
the literature also mentions some fringe benefits of using DH: an easier
identification of a tumor margins, decreased operating time, decrease of the
amount of sutures and cauterizations within surgical wound. It has to be
mentioned that some of the above advantages are not proved, yet.
Indications of DH
A first question to be asked is if indeed DH reduces blood loss during
surgery!
This question could be considered obsolete but some data from literature
show that there is no linear correlation between blood pressure (BP) decrease and amount of blood loss. Beside, it seems that in many cases correct
patient positioning as well as positive pressure ventilation (by reducing the
venous return) could have a similar beneficial effect on blood loss.
But with all the question marks raised by some clinical studies, one thing
is clear: DH does produce a decrease in the amount of blood loss during
those procedures in which massive blood loss is expected.
 Ben Gurion University of the Negev and Mayney Hayeshuah Medicl Center, Israel
gurman@bgu.ac.il
Timioara 2010

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