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Article

The Effect of Hypotensive Anesthesia on Hemoglobin Levels during Total Knee Arthroplasty

1
Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA
2
Department of Orthopedics and Tumor Orthopedics, University of Muenster, 48149 Muenster, Germany
3
Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA
4
Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(1), 57; https://doi.org/10.3390/jcm10010057
Received: 20 November 2020 / Revised: 19 December 2020 / Accepted: 22 December 2020 / Published: 26 December 2020
(This article belongs to the Special Issue State-of-the-Art Research on Hip and Knee Arthroplasty)
Introduction: Hypotensive epidural anesthesia (HEA) is used in total joint arthroplasty as a safe and effective blood-saving modality. In order to maintain the blood pressure and heart rate patients, receive 1000 to 1500 mL of lactated Ringer’s solution during surgery. While HEA reduces the intraoperative blood loss, the effect of intravenous fluid loading on hemoglobin levels is not fully understood. The current study investigates the effect of HEA on perioperative hemoglobin levels. Materials and Methods: The study included 35 patients operated on by a single surgeon undergoing primary total knee arthroplasty under HEA. Intraoperatively, at least 300 mL of intravenous fluid were given every 15 min over the first 60 min after HEA. Blood samples were drawn before entering the operating room, after HEA, as well as after inflation of the tourniquet, every 15 min thereafter, as well as in the recovery room and on postoperative days one and two. In addition, fluid in- and outtake was recorded. Results: Patients received a mean 1275 mL during the 60 min of tourniquet time. The mean arterial pressure (MAP) 5 min after HEA dropped to 60 mmHg and reached a constant level of around 58 mmHg 15 min after HEA. The average hemoglobin level dropped from 13.9 g/dL prior to HEA, to 12.5 g/dL immediately after HEA (p < 0.001). Intraoperatively the hemoglobin level dropped further and reached 11.8 g/dL at 60 min in the absence of blood loss. Conclusions: Hypotensive epidural anesthesia and the resulting fluid substitution resulted in an average hemoglobin drop of 2.1 g/dL within the first 60 min. This needs to be taken into account when evaluating the need for blood transfusions after primary joint replacement surgery under HEA. View Full-Text
Keywords: hypotensive anesthesia; total knee arthroplasty; hemoglobin levels; blood transfusions; blood-saving modality hypotensive anesthesia; total knee arthroplasty; hemoglobin levels; blood transfusions; blood-saving modality
MDPI and ACS Style

Schmidt-Braekling, T.; Goytizolo, E.; Waldstein, W.; Sharrock, N.; Boettner, F. The Effect of Hypotensive Anesthesia on Hemoglobin Levels during Total Knee Arthroplasty. J. Clin. Med. 2021, 10, 57. https://doi.org/10.3390/jcm10010057

AMA Style

Schmidt-Braekling T, Goytizolo E, Waldstein W, Sharrock N, Boettner F. The Effect of Hypotensive Anesthesia on Hemoglobin Levels during Total Knee Arthroplasty. Journal of Clinical Medicine. 2021; 10(1):57. https://doi.org/10.3390/jcm10010057

Chicago/Turabian Style

Schmidt-Braekling, Tom, Enrique Goytizolo, Wenzel Waldstein, Nigel Sharrock, and Friedrich Boettner. 2021. "The Effect of Hypotensive Anesthesia on Hemoglobin Levels during Total Knee Arthroplasty" Journal of Clinical Medicine 10, no. 1: 57. https://doi.org/10.3390/jcm10010057

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