인공고관절전치환술에 있어서 서로 다른 마취 방법에 따른 실혈량의 비교

Abstract

Backgroud: The mean blood loss is about 500-1,700 ml by general anesthesia technique in total hip replacement (THR) and the amout of blood of blood loss is dependent on the degree of induced hypotension. We performed this study to evaluate the differences on the amount of blood loss and the number of transfused patients according to different anesthetic techmique under the similar hypotension level. Methods: Forty-seven patients of ASA physical stauts class 1, 2 and 3, scheduled for THR, were randomly assigned into epidural anesthesia group (E group), combined general epidural anesthesia group (GE group) and general anesthesia group (G group). G group was maintained with sevoflurane anesthesia and the monitoring of central and arterial blood pressure was performed. The remifentail (0.1μg/kg/min) was infused continuously for the target mean arterial pressure of 60 ± 5 mmHg. GE group recevied general anesthesia withe the same technique fo G group and epidural anestheia was combined after general anesthesia. The remifentanil (0.1μg/kg/min) was infused continuously for the target mean arterial blood preseeure of 60 ± 5 mmHg. E group received epidural anesthesia with 0.75% ropivacaine and additional bolus dose of local anesthetics was injected if the mean arterial blood pressure did not reach 60 ± 5 mmHg. Recults: The mean volume of blood loss and the number of transfused patients was significantly less in E of GE group at 24 hour after surgery (P < 0.05), however we could not find any signigicant differences during intraoperative period. Conclusions: Epidural of combined general epidural anesthesia technique is a good method to reduce bleeding and the number of transfused patientis.