A deliberate hypotensive technique for decreasing blood loss during radical hysterectomy and pelvic lymphadenectomy.

Nitroglycerin was utilized in combination with general anesthesia in order to reduce mean arterial blood pressure with the objective of reducing operative blood loss in 26 consecutive patients undergoing radical hysterectomy and pelvic lymphadenectomy. This deliberate hypotensive technique added no morbidity and compared to a control group decreased the blood loss by 70%, shortened operating time by 29.5%, and decreased the percentage of patients requiring blood transfusions from 81% to 11.5%. The indications for controlled hypotension are still controversial and somewhat dependent upon the expertise of the anesthesia and surgery teams, availability of blood, and the risk of transfusion hepatitis. Cerebrovascular disease, myocardial ischemia, peripheral vascular disease, severe renal or hepatic disease, and hypovolemia are relative contraindications to deliberate hypotension.