To the Editor:—

In their recent review, ‘Eliminating Blood Transfusions: New Aspects and Perspectives,‘ Spahn and Casutt 1devote only five sentences and cite only two references to the method of controlled hypotension, and they create the impression that this method has limited safety, efficacy, and applicability. This contradicts the many articles, book chapters, and books that have been written on behalf of this subject, 2–5and it contradicts the experience of many experts in the field. Of course, skill, experience, and vigilance are essential for the conduct of safe and effective controlled hypotension.

We recognize that a review article on such a broad topic cannot be totally comprehensive; however, we believe that controlled hypotension warrants a more in-depth discussion. Our concern is that a lack of attention to the science and art of controlled hypotension will result in the technique’s not being passed on to the next generation of anesthesiologists. This would deprive these practitioners and, more importantly, their patients of a useful and safe method of blood conservation.

Spahn DR, Casutt M: Eliminating blood transfusions: New aspects and perspectives. A nesthesiology 2000; 93: 242–55
Enderby GEH: Hypotensive Anaesthesia. London, Churchill-Livingstone, 1985
Klowden AJ, Salem MR, Fahmy NR, Crystal GJ: Deliberate hypotension, Blood Conservation in the Surgical Patient. Edited by Salem MR. Philadelphia, Williams & Wilkins, 1996, pp 189–251
Induced Hypotension. Edited by MacRae WR, Wildsmith JAW. Amsterdam, Elsevier, 1991
Salem MR: Deliberate hypotension is a safe and accepted anesthetic technique, Controversy in Anesthesiology. Edited by Eckenhoff JE. Philadelphia, WB Saunders, 1979, pp 93–104