Table 1 Characteristics of included studies
Study ID | Locations | Sample sizes | Intervention groups | Comparison groups | Age range (years) | MAP levels (mmHg, DH group) | MAP levels (mmHg, C group) | Definitions of intraoperative blood loss | Types of surgeries | Anesthesia | Overall mortality | Occurrence of serious adverse events |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
An 2015 [40] | China | 60 | Remifentanil | DH + ANH vs. ANH | 37–64 | 60–70 | 70–80 | Not stated | Complicated orthopedic | GA | Y (24h post-op) | Y (24h post-op) |
Cheng 2003 [41] | China | 30 | Remifentanil | DH+AHH vs. AHH | 19–65 | 55–65 | 89 ± 9.1 | Increased weight of gauzes | Orthopedic | GA | N (24h post-op) | N (24h post-op) |
Chi 2005 [42] | China | 29 | Remifentanil | DH vs. C | 22–61 | 55–65; 65 ± 7 | 90 ± 10 | Blood collected in suction bottles and increased weight of gauzes | Orthopedic (spine or joint) | GA | N (> 1 h post-op) | N (> 1 h post-op) |
Diao 2006 [43] | China | 40 | Nitrates | DH vs. C | 71–79 | 70% of baseline; no less than 60 | Not stated | Not stated | THA | GA | N (4 days post-op) | N ( days post-op) |
Dong 2012 [44] | China | 54 | Drug combination | DH vs. C | 44–78 | 70% of baseline | 86 ± 8 | Not stated | THA | GA | N (4 days post-op) | N (4 days post-op) |
Fang 2011 [45] | China | 37 | Remifentanil | DH + ANH vs. ANH | 38–65 | 70% of baseline | ANH: 87 ± 4; C: 85 ± 6 | Not stated | Orthopedic | GA | N | N |
38 | Nitrates | DH + ANH vs. ANH | ||||||||||
Fukusaki 2008 [46] | Japan | 30 | Sevoflurane | DH + AHH+ A vs. AHH+ A | 51–70 | 55 | 95 | Weighing swabs and measuring blood collected from wound drainage. | THA | GA | N (7 days post-op) | Y (7 days post-op) |
Han 2006 [47] | Korea | 56 | Esmolol | DH + ANH vs. ANH | < 65 | 55–65 (57.3 ± 4.4) | 85.1 ± 5.7 | Not stated | Posterior lumbar fusion | GA | N (7 days post-op) | Y (1 week post-op) |
Hu 2005 [48] | China | 20 | Nitrates | DH + AHH vs. AHH | 38–65 | 55–65 | 70–100 | Increased weight of gauzes. | THA | SA + EA | N | N |
Hwang 2013 [49] | Korea | 40 | Milrinone | DH vs. C | 60–70 | ≤ 60 | Not stated | Blood in suction bottle and weighing the wet gauzes | Posterior lumbar fusion | GA | N | N |
Jin 2008 [50] | China | 60 | Nitrates | DH + AHH + A vs. AHH + A | 48–66 | 65 ± 5 | 86.7 ± 10.3 | Not stated | THA | GA | N (unclear) | Y (unclear) |
Kazemi 2006 [51] | Iran | 60 | Nitrates | DH vs. C | 20–60 | 85% of baseline | 94% of baseline (85–95) | Blood in suction container and degree of wetness of used sponges were estimated | Open fixation of femur fracture | GA | Y (unclear, during hospital stay) | Y (unclear, during hospital stay) |
Li 2012 [52] | China | 50 | Drug combination | DH vs. C | 51–86 | 70% of baseline | Not stated | Not stated | THA | EA+SA | N | N |
Liang 2004 [53] | China | 24 | Nitrates | DH + AHH vs. AHH | 41–63 | 70% of baselineDH + AHH: 61 ± 6; DH: 63 ± 4 | AHH: 89 ± 8; C: 95 ± 12 | Blood collected in suction bottles and estimated blood in gauzes | Orthopedic | GA | N (24 h post-op) | N (24 h post-op) |
24 | Nitrates | DH vs. C | ||||||||||
Liu 2009 [55] | China | 60 | Nitrates | DH vs. C | 65–82 | Decreased by 30% of baseline, and not less than 55 | 86 ± 16 | Not stated | THA | GA | N (4 days post-op) | N (4 days post-op) |
Liu 2011 [56] | China | 40 | Drug combination | DH vs. C | 65–82 | 70% baseline and no less than 60 | 88 ± 5 | Not stated | THA | GA | N (4 days post-op) | N (4 days post-op) |
Liu 2014 [54] | China | 60 | Sevoflurane | DH + A vs. A | 65–83 | 65–75 | 86.2 ± 8.6 | Not stated | Unilateral THA | GA | N (48 h post-op) | N (48 h post-op) |
Luo 2011 [57] | China | 60 | Drug combination | DH vs. C | 30–62 | 55.7 ± 6.9 | 85.3 ± 10.4 | Blood collected in suction bottles, blood loss of gauzes and salt water towel. | Spine surgery | GA | N | N |
Niemi 2000 [58] | Finland | 30 | Epidural anesthesia | DH vs. C | Not stated | 50–60 | Not stated | Contents of suction bottles and increase in weight of surgical swabs | Unilateral THA | EA in DH group and SA in C group | N (next morning of surgery) | N (next morning of surgery) |
Wang 2012 [59] | China | 23 | Remifentanil | DH vs. C | 50–65 | 70% of baseline (no less than 55): | 79 ± 12 | Not stated | THA | GA | N | N |
22 | Nitrates | DH vs. C | ||||||||||
Wu 2000 [60] | China | 20 | Nicadipine | DH vs. C | Not stated | 60–65 | 95 ± 4.6 | Blood collected in suction bottles and the increased weight of gauzes. | Intervertebral disc pick out and vertebra planted bone | GA | N (unclear) | Y (unclear) |
Xiao 2005 [61] | China | 37 | Nitrates | DH vs. C | Not stated | 60–65 | Not stated | Not stated | Internal fixation of vertebral or pelvic fracture; spinal tumor resection | GA | N | N |
38 | drug combination | DH vs. C | ||||||||||
Xiong 2015 [62] | China | 40 | Nitrates | DH + AHH vs. AHH | 50–73 | 65 ± 5 | Not stated | Not stated | THA | GA | N | N |
Yang 2002 [63] | China | 50 | Nitrates | DH vs. C | Not stated | 60–70% of baseline | Not stated | Blood collected in suction bottles and the increased weight of gauzes. | Cervical posterior decompression | GA | N | N |
Yuan 2015 [64] | China | 40 | Nitrates | DH + AHH vs. AHH | 48–62 | 65 ± 5 | Not stated | Blood collected in suction bottles and increased weight of gauzes. | Internal fixation of thoracolumbar spine | GA | N | N |
40 | Nitrates | DH vs. C | ||||||||||
Zhai 2011 [65] | China | 30 | Drug combination | DH vs. C | 18–59 | 55–65 | Not stated | Not stated | Posterior lumbar decompression and bone grafting | GA | N (5 days post-op) | N (5 days post-op) |
30 | 45–50 | |||||||||||
Zhang 2009 [66] | China | 20 | Remifentanil | DH + AHH vs. AHH | 22–54 | 68 ± 5 | AHH: 83 ± 5; C: 86 ± 7 | Not stated | Fixation of vertebral pedicle | GA | N | N |
Zhu 2006 [68] | China | 40 | Nicadipine | DH vs. C | Not stated | 60–65 | Not stated | Not stated | THA; internal fixation of femoral fracture | GA + EA | N (2 days post-op) | N (2 days post-op) |
Zhu 2007 [67] | China | 24 | Drug combination | DH + AHH vs. AHH | 35–65 | 75% of baseline | AHH: 70–90; C: 70–100 | Blood collected in suction bottles and increased weight of gauzes | Spinal surgery | GA | N (1 day post-op) | N (1 day post-op) |
Zhu 2009 [69] | China | 60 | Drug combination | DH vs. C | 25–58 | 60–65 | Not stated | Not stated | THA; internal fixation of femoral fracture | GA | N (2 days post-op) | N (2 days post-op) |
Zhu 2013 [70] | China | 45 | Nicadipine | DH vs. C | 30–60 | 60–65 | Not stated | Not stated | THA, internal fixation of femoral fracture | GA | N (2 day post-op) | N (2 day post-op) |
45 | Drug combination |