Does timing of hemodilution influence the stress response and overall outcome?

This study was designed to assess the stress response of acute hemodilution (AH) in patients subjected to radical cystectomy. Forty adult male patients were randomly allocated into a control group (n = 10) where homologous blood transfusion was used, a preinduction AH group (n = 20) where AH was performed before lumbar epidural block and induction of anesthesia, and into a postinduction group (n = 10) where AH was performed after induction of anesthesia. Monitored variables included hemodynamic, hematological and coagulation factors, liver function tests, and serum hormones. AH performed in awake or in anesthetized patients did not result in significant hemodynamic disruption, or result in detectable end-organ or stress-hormone changes when compared to control patient outcomes after radical cystectomy. Hemodilution can be performed by protocol for patients who are undergoing this procedure without major adverse effects.