Combination Of Acute Hypervolemic Hemodilution And Controlled Hypotension During Operation Of Sacral Chordoma

BACKGROUNDHemodilution techniques and controlled hypotension are well known measures to minimise blood loss, as well as to reduce allogeneic transfusion complications. Acute hypervolemic hemodilution(AHH) is a relatively new means of dilution of erythrocytes by creating hypervolemia with colloids or crystalloids in an attempt to reduce erythrocyte loss. Total resection of sacral tumor always combines with a great deal ofblood loss. In order to reduce allogeneic blood transfusion during operation, combination of acute hypervolemic hemodilution and controlled hypotension were used by us as an integrated blood conservation program.CASE REPOETA 42-year-old female patient weighing 65 kg, ASA (American Society of Anestesiologists) classification I, without medical history, suffered from low-back pain for 3 months and urinary dysfunction for 1 week was admitted to our hospital and diagnosed sacral chordoma. General anesthesia was selected for the operation. 0.3 mg scopolamine and 3 mg medazolin midazolam was given as intramuscular premedication. General anaesthesia was induced by administration of 7 mg medazolin, 0.3 mg fentanyl, 8 mg pancuronium and 30 mg propofol followed by inhalation of 1% isoflurane, with additional doses of 2 mg pancuronium and 0.1 mg fentanyl. After induction of anesthesia, AHH was produced by infusion of 1300ml of HES through right jugular vein. Invasive blood pressure(BP) by leftradial artery, ECG(electrocardiogram), SaO2(oxygen saturation), EtCO2(end tidal carbon dioxide), CVP(central venous pressure) and urine output were monitored continually. Sodium nitroprusside were given at the beginning of AHH at 1g/(kg.min) and adjusted to maintain the stabilization of BP and CVP during AHH. During surgical manipulation with the sacrum, controlled hypotension (mean blood pressure at 8.0 kPa for 85min) was maintained by application of nitroprusside sodium. The values of haemoglobin and haematocrit were checked every 40 min. Haematocrit value decreased from 0.39 to 0.31 and haemoglobin value decreased from 131 to 103 g/1 after AHH. The total blood loss was 2800 ml during the operation and a total volume of 3000 ml of colloids and 4000 ml of crystalloids were supplied. The total transfusion was 4 U red blood cell(transfusion trigger was haematocrit -0.20) and 500 ml fresh frozen plasma at the end of operation. The patient was haemodynamically stable during the operation and extubated at the postoperative unit without complications.