In Reply:—

We appreciate the comment of Dr. Sharrock to our letter 1and review article. 2Four randomized studies are cited in which blood loss was reduced by hypotensive anesthesia. 3–6In three studies with a total of 425 patients, 3,4,6the reduction of blood loss was 13–130 ml without reduction of allogeneic blood transfusion. In one small study with 30 patients, blood loss was reduced by 500 ml, and also a reduction of allogeneic blood transfusion was observed. 5In general, the blood sparing potential of hypotensive anesthesia is limited.

1.
Spahn DR, Casutt M: Eliminating blood transfusion: What about hypotensive anesthesia? (letter). A nesthesiology 2001; 94: 543
2.
Spahn DR, Casutt M: Eliminating blood transfusions: New aspects and perspectives. A nesthesiology 2000; 93: 242–55
3.
Williams-Russo P, Sharrock NE, Mattis S, Liguori GA, Mancuso C, Peterson MG, Hollenberg J, Ranawat C, Salvati E, Sculco T: Randomized trial of hypotensive epidural anesthesia in older adults. A nesthesiology 1999; 91: 926–35
4.
Sharrock NE, Mineo R, Urquhart B, Salvati EA: The effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty performed under lumbar epidural anesthesia. Anesth Analg 1993; 76: 580–4
5.
Niemi TT, Pitkanen M, Syrjala M, Rosenberg PH: Comparison of hypotensive epidural anaesthesia and spinal anaesthesia on blood loss and coagulation during and after total hip arthroplasty. Acta Anaesthesiol Scand 2000; 44: 457–64
6.
Winkler M, Akca O, Birkenberg B, Hetz H, Scheck T, Arkilic CF, Kabon B, Marker E, Grubl A, Czepan R, Greher M, Goll V, Gottsauner-Wolf F, Kurz A, Sessler DI: Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg 2000; 91: 978–84