Controlled hypotensive anesthesia to reduce blood loss in radical cystectomy for bladder cancer

Controlled intraoperative hypotension has been reported to reduce blood loss in major cancer operations. We did a retrospective evaluation on the effects of induced controlled hypotensive anesthesia using enflurane or trimethaphan compared to standard normotensive anesthesia in 37 consecutive patients who were undergoing single stage radical cystectomy with pelvic lymphadenectomy and bilateral ureteroileal cutaneous urinary diversion. Group 1 contained 16 patients who received induced hypotensive anesthesia and group 2 contained 21 patients who received normotensive anesthesia. Average age, pathological stage, and hematocrit values preoperatively and 5 days postoperatively were not significantly different. The average blood loss in group 1 was 821 plus or minus 78 cc and in group 2 it was 1,740 plus or minus 132 cc, a difference of 919 cc (p less than 0.001). Concomitantly, total blood replacement was significantly different. The hypotensive group required an average of 1.38 plus or minus 0.25 units or 700 plus or minus 100 cc and the normotensive group averaged 3.25 plus or minus 0.45 units or 1,600 plus or minus 225 cc (p less than 0.05). In addition, only 69 per cent of the hypotensive group required blood replacement compared to 90 per cent of the normotensive group. Our data demonstrate that controlled hypotensive anesthesia markedly reduces blood loss for radical bladder cancer surgery.