Feasibility of administering acute hyper-volemic hemodilution on patients undergone bone surgery

Objective:To investigate the feasibility of administering acute hypervolemic hemodilution(AHH)on patients undergone bone surgery under general anesthesia combined with continuous epidural block.Methods:Twenty-eight ASA class Ⅰ or Ⅱ patients undergone elective bone surgery under general anesthesia combined with continuous epidural block were enrolled in this study.The patients were randomized into two groups:AHH group(acute hypervolemic hemodilution group)and C group(control group),with 14 cases in each one.Lactated Ringer solution was infused at 6～8 ml/kg before anesthesia.After correct placement of epidural was confirmed,radial artery were cannulated for BP monitoring and right internal jugular vein was inserted into monitor CVP,BP,ECG,SpO-2 and P-{ET}CO-2 were continuously monitored before and during anesthesia.After a mixture of 1.33% lidocaine with 0.167% dicaine 10 ml was injected via the epidural cather.AHH group was then conducted with 6% hydroxyethyl starch(HES)20 ml/kg infused iv at 50 ml/min.Control group was transfused commonly.Anesthesia was induced with fentanyl 2 μg/kg,midazolam 0.1 mg/kg and propofol 1.5 mg/kg.Tracheal intubation was facilitated with rocuronium 0.6 mg/kg and anesthesia was maintained with isoflurane.After induction,the end-tidal isoflurane concentration was maintained at ±1.2%.The MAP,HR,CVP,electrolyte and blood sugar(BS)were determined before AHH(T0),at 15 min(T-1)and the end of operation(T-2).The determination of Hct and Hb were recorded in the first day before and after operation(T-3).The volume of infusion,blood loss and blood transfusion were measured during operation.Results:After hemodilution,the CVP in AHH group was increased,but in normal range.Compared with group C,MAP and HR in AHH group were maintained stable.Hct and Hb in AHH group after hemodilution were decreased in comparison with pre-operation.The amount of transfusion and urinary production during the operation in AHH group were increased in comparison with group C.Blood sugar level in both groups at T-1 and T-2 was significantly higher than that at T-0(P0.05).There showed no significant differences in the serum electrolyte level(P0.05).Conclusion:Acute hypervolemic hemodilution(AHH)can be used safely during operation of orthopaedics under general anesthesia combined with continuous epidural block in terms of hemodynamic change.