Preoperative Acute Normovolaemic Hemodilution (ANH) in combination with Hypotensive Epidural Anaesthesia (HEA) during knee arthroplasty surgery. No effect on transfusion rate. A randomized controlled trial [ISRCTN87597684]

BACKGROUND: Hypotensive epidural anaesthesia (HEA) combines a high epidural anaesthesia, performing a sympathetic blockade, with low-dose iv-infusion of epinephrine to stabilize circulation in the conscious patient. Mean artery blood pressure is reduced to 45–50 mmHg and hereby a reduced blood loss. In this study we have combined HEA with preoperative acute normovolaemic hemodilution (ANH) in attempt to further reduce the blood loss and need for blood transfusion in total knee arthroplasty surgery (TKR). METHODS: Twenty-eight patients scheduled for TKR are randomised to ANH or no hemodilution (non-ANH). Both groups are anaesthetized with HEA. ANH is established with predonation of 20 % of the total blood volume, and replacement with equal volume of HAES 6 %. Blood re-transfusion is completed within 6 h. RESULTS: A mean of 877 ml blood was predonated (19.7 % of the total blood volume). Blood loss was, except from the intraoperative loss, significantly higher in ANH group. The total loss was 1306 mL (ANH) vs. 1026 mL (non-ANH), p < 0.05. Except from the first hour postoperatively, hematocrit was identical in between groups postoperatively. The amount of blood transfusion was identical 386 ml (ANH) vs. 343 ml (non-ANH) (ns). 50 % went through surgery without receiving blood (ANH) vs. 58 % (non-ANH). No renal, neurological or cardiopulmonary complications were registered. CONCLUSIONS: These data suggest no benefits in combining HEA and ANH in TKR surgery. Probably because of the reduced viscosity of the blood after ANH, there is an increased postoperative blood loss. The need for homologous blood transfusion was identical

Reconciling the Metallicity Distributions of Gamma-ray Burst, Damped Lyman-alpha, and Lyman-break Galaxies at z=3

We test the hypothesis that the host galaxies of long-duration gamma-ray bursts (GRBs) as well as quasar-selected damped Lyman-alpha (DLA) systems are drawn from the population of UV-selected star-forming, high-z galaxies (generally referred to as Lyman-break galaxies). Specifically, we compare the metallicity distributions of the GRB and DLA populations to simple models where these galaxies are drawn randomly from the distribution of star-forming galaxies according to their star-formation rate and HI cross-section respectively. We find that it is possible to match both observational distributions assuming very simple and constrained relations between luminosity, metallicity and HI sizes. The simple model can be tested by observing the luminosity distribution of GRB host galaxies and by measuring the luminosity and impact parameters of DLA selected galaxies as a function of metallicity. Our results support the expectation that GRB and DLA samples, in contrast to magnitude limited surveys, provide an almost complete census of z=3 star-forming galaxies that are not heavily dust-obscured.Comment: 31 pages, 6 figures. Accepted for publication in Ap