الفهرس 
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Abstract
Introduction: Major orthopedic surgery specially hip surgery faces many challenges, intraoperative bleeding with hazard of blood transfusion and postoperative pain represent the most serious challenges which the surgeons and anesthesiologist face. Patients and physicians continue to be motivated to find methods to reduce the use of allogeneic blood. Even thorough donor screening has increased the safety of donated blood products, autologus blood is the most desirable source of red cells during the perioperative period. The methods commonly used to be obtained autologus blood during the perioperative period can be initiated perior to the operative procedure (autologus preoperative donation, acute normovolemic hemodilution) or during surgery (cell scavenging) and hypotensive anesthesia.
Aim of Work: In this study we compare the results of acute normovolemic hemodilution with colloid and crystalloid based on volume replacement regimen in elderly patients undergoing hip replacement surgery. Also, we evaluate the results of continuous psoas compartment block on hemodynamic stability and postoperative analgesia in these particular elderly patients.
Patients & Methods: This randomized prospective study was performed on patients with hip replacement under general anesthesia. Patients were randomly assigned into three groups, using the closed envelop method: Control group without ANH (n=20); Crystalloid with ANH group (n=20) and Colloid with ANH group (n=20). In all Groups before induction of anesthesia, the posterior lumbar plexus blockade was performed using the landmarks of Winne and colleagues (1974) with an epidural catheter for continuous psoas compartment block. Premedication performed by giving a 10 mg of diazepam per oral one hour before surgery. A radial artery catheter was inserted for continuous monitoring of arterial pressure and for obtaining blood sample. Central venous catheter was inserted for measuring central venous pressure and for obtaining blood sample. To facilitate measurement of urinary output and for obtaining urine sample urinary catheter must be inserted.
Results: General anesthesia was induced with IV administration of propofol 1.5-2,5mg/kg and IV administration of fentanyl (1-3ug/kg) tracheal intubation facilitated with atracorium (0.5-0.7mg/kg). Anesthesia was maintained with sevoflurane (1.5MAC), minute ventilation and fresh gas flow at (4liter oxygen) are adjusted to maintain an end-tidal CO2 of 4.0-4.6 KPa, with maintenance of muscle of muscle relaxant by atracorium (0.1mg/kg) in all groups. Acute normovolemic hemodilution was carried out prior to induction of anaesthesia by drawing 900 ml of blood from a venous catheter located in cubital vein into standard blood bags. The blood drained was replaced by 900 ml of colloid (HES) in group c colloid or 1800mlof 0.9% saline in crystalloid group. Standard monitoring were applied to measure Heart rate (HR), Arterial blood pressure, Central venous pressure (CVP), these hemodynamic parameters are measured immediately preoperatively and every 10 minute intraoperatively and immediately postoperatively, Arterial oxygen tension (PaO2), Venous oxygen tension (PvO2), Serum creatinine level, Red blood cells (RBCs) count, Hematocrit (HCT), Hemoglobin level and Leucocytic count.
Conclusion: Patients undergoing total hip replacement with psoas compartment block acute normovolemic hemodilution with colloid produce more hemodynamic stability and anti-inflammatory action than acute normovolemic hemodilution with crystalloid whether crystalloid solution had better performance regarding the renal function tests.