[Controlled hypotension in transthoracic esophageal resection]

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Transthoracic esophageal resection involves significant blood loss.
• Minimizing blood loss and optimizing surgical conditions are crucial for patient outcomes.
• Controlled hypotension is a potential strategy to address these challenges.

Purpose of the Study:

• To evaluate the effectiveness of controlled hypotension in reducing blood loss during transthoracic esophageal resection.
• To compare outcomes between patients managed with controlled hypotension and those with standard anesthesia.

Main Methods:

• A randomized study of 36 patients undergoing transthoracic esophageal resection.
• Group T (n=18) received controlled hypotension via thoracic epidural anesthesia (mean arterial pressure ~50 mmHg).
• Group K (n=18) received standard endotracheal anesthesia (mean arterial pressure 80-110 mmHg).
• Evaluated intra-operative and post-operative blood loss, operating time, anesthetic use, and ICU stay.

Main Results:

• Intra-operative blood loss was 45.7% lower in the controlled hypotension group (Group T).
• Mean operation time was 14.2% shorter in Group T.
• Group T used 80% less fentanyl and 43% less inhaled anesthetics.
• ICU stay was shorter in Group T (2.6 days vs. 3.9 days).
• No significant complications were attributed to controlled hypotension.

Conclusions:

• Controlled hypotension is effective in reducing blood loss and the need for transfusions in transthoracic esophageal resection.
• This technique improves surgical conditions and reduces operative time.
• Controlled hypotension did not result in serious intra- or post-operative cardiac, neurological, or renal complications.