Effectiveness of Acute Normovolemic Hemodilution to Minimize Allogeneic Blood Transfusion in Major Liver Resections

Matot, Idit; Scheinin, Olga; Jurim, Oded; Eid, Ahmed Salem

doi:10.1097/00000542-200210000-00008

Cited by 133 publications

(89 citation statements)

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“…20 However, there are conflicting data regarding the effectiveness of ANHD for reducing transfusion requirements during liver resection and major gastrointestinal surgery. 12,[20][21][22][23][24][25] After adopting perioperative modifications including more-frequent use of ANHD and in-line fluid warmers-rates of hypothermia, hypotension, transfusions, and overall intraoperative adverse events significantly decreased in our patients. Although it is not possible to extrapolate the presence of a causative relation between adopting perioperative modifications and a significant decrease in the rate of intraoperative adverse events, our findings point toward a beneficial effect for these changes.…”

Section: Discussionmentioning

confidence: 78%

Incidence and Risk Factors of Intraoperative Adverse Events During Donor Lobectomy for Living-Donor Liver Transplantation: A Retrospective Analysis

Araz¹,

Pirat²,

Unlukaplan³

et al. 2012

Exp Clin Transplant

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Results: Ninety-one patients (50%) had at least 1 intraoperative adverse event including hypothermia (39%), hypotension (26%), need for transfusions (17%), and hypertension (7%). Patients with an adverse event were older (P = .001), had a larger graft weight (P = .023), more frequently underwent a right hepatectomy (P = .019), and were more frequently classified as American Society of Anesthesiologists physical status class II (P = .027) than those who did not have these adverse events. Logistic regression analysis revealed that only age (95% confidence interval 1.018-1.099; P = .001) was a risk factor for intraoperative adverse events. Patients with these adverse events more frequently required admission to the intensive care unit and were hospitalized longer postoperatively. A before and after analysis showed that after introduction of in-line fluid warmers and more frequent use of acute normovolemic hemodilution, the frequency of intraoperative adverse events was significantly lower (80% vs 29%; P < .001). Conclusions:Intraoperative adverse events such as hypothermia and hypotension were common in living-donor liver transplant donors, and older age was associated with an increased risk of these adverse events. However, the effect of these adverse events on postoperative recovery is not clear.

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Section: Discussionmentioning

confidence: 78%

Incidence and Risk Factors of Intraoperative Adverse Events During Donor Lobectomy for Living-Donor Liver Transplantation: A Retrospective Analysis

Araz¹,

Pirat²,

Unlukaplan³

et al. 2012

Exp Clin Transplant

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“…29,30 When the blood loss exceeds 90% of the patient's blood volume ANH alone may not be able to prevent exposure to allogenic blood, but it may reduce the number of allogenic units transfused. 31 Volume of blood that can be withdrawn is calculated as follows…”

Section: Acute Normovolemic Hemodilution(anh)mentioning

confidence: 99%

Blood conservation strategies in orthopedic surgeries: A review

Sambandam

Batra

Agrawal

2013

Journal of Clinical Orthopaedics and Trauma

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a b s t r a c tIn orthopedics management of surgical blood loss is an important aspect which has evolved along with modern surgeries. Replacement of lost blood by transfusion alone is not the answer as was considered earlier. Complications like infection and immune reaction due to blood transfusion are a major concern. Today numerous techniques are available in place of allogenic blood transfusion which can be employed safely and effectively. In this article we have reviewed these techniques, their merits and demerits.

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“…Šios aplinkybės skatina siaurinti ir griežtinti indikacijas donorinio kraujo perpylimui, įdiegti naujus metodus, padedančius išvengti ar bent minimalizuoti alogeninio kraujo transfuzijų poreikį (10)(11)(12)(13)(14)(15)(16)(17).…”

Section: įVadasunclassified

“…Jei ūminės normovoleminės hemodiliucijos metu buvo paruošti keli maišeliai su autologiniu krauju, pirmiausia reinfuzuojamas vėliausiai už-pildytas maišelis (jame yra mažiausia trombocitų ir krešėjimo faktorių koncentracija). Autologinio kraujo saugojimo terminas trumpas, todėl bakterinės kontaminacijos rizika minimali (12,13,25,27).…”

Section: ūMinė Normovoleminė Hemodiliucijaunclassified

Transfusion of autologous blood

Veikutienė¹,

Širvinskas²,

Adukauskienė

2008

Medicina

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ĮvadasPastaraisiais metais, nuolat daugėjant sudėtingų traumų (jų metu nukentėjęs žmogus dažnai labai nukraujuoja), didėjant įvairių ligų chirurginio gydymo galimybėms, plečiantis ortopedinių operacijų apimčiai, didėja alogeninio kraujo perpylimo poreikis (1). Deja, alogeninio kraujo perpylimas susijęs su daugeliu problemų: kraujo, kaip biologinio audinio, išteklių ribotumu, augančiais kraujo paruošimo kaštais, krauju perduodamų infekcinių ligų pavojumi, neigiamu imunomoduliaciniu poveikiu recipientui, pneumonija bei kitomis pooperacinėmis infekcijomis, piktybinių navikų išplitimo bei jų atsinaujinimo rizika (2-9). Yra duomenų, kad alogeninio kraujo perpylimas didina sergamumą, mirtingumą, ilgina lovadienių trukmę intensyviosios terapijos skyriuose gydomiems ligoniams (8).Šios aplinkybės skatina siaurinti ir griežtinti indikacijas donorinio kraujo perpylimui, įdiegti naujus metodus, padedančius išvengti ar bent minimalizuoti alogeninio kraujo transfuzijų poreikį (10-17).Autologinio kraujo perpylimas -tai yra, kai donoras ir recipientas yra tas pats asmuo (paties ligonio kraujo perpylimas). Pastaraisiais metais akivaizdžiai padidėjo susidomėjimas autologinio kraujo panaudojimo galimybėmis, kaip viena tinkamiausių alternatyvų donorinio kraujo perpylimui. Šiuolaikiniai autologinio kraujo moksliniai tyrimai bei klinikinė praktika pateikia naują sampratą apie autologinio kraujo perpylimo praktinę vertę. Autologinio kraujo perpylimas yra pats saugiausias, nes galima išvengti ar bent gerokai sumažinti daugelį potencialių komplikacijų, sukeliamų donorinio kraujo perpylimo. Svarbus autologinio kraujo perpylimo vaidmuo ir kraujo taupymo programoje. Šis kraujo perpylimas geriausias, o dažnai ir vienintelis pasirinkimo būdas tiems ligoniams, kuriems tapataus donorinio kraujo nepavyksta parinkti, kai yra itin reto fenotipo kraujo grupė arba dėl imunizacijos susidarę aloantikūnai (18).Ne visos planinės chirurginės intervencijos susijusios su didesniu nukraujavimu, todėl ne visi ligoniai turėtų būti ruošiami autologinio kraujo perpylimui. Yra keletas autologinio kraujo perpylimo metodų, kurie skirtingiems ligoniams gali būti naudojami atskirai ar įvairiuose deriniuose.Autologinio kraujo perpylimo metodai:

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Effectiveness of Acute Normovolemic Hemodilution to Minimize Allogeneic Blood Transfusion in Major Liver Resections

Abstract: Acute normovolemic hemodilution in patients with American Society of Anesthesiologists status I-II undergoing major liver resection may allow a significant number of patients to avoid exposure to allogeneic blood.

Cited by 133 publications

References 0 publications

Incidence and Risk Factors of Intraoperative Adverse Events During Donor Lobectomy for Living-Donor Liver Transplantation: A Retrospective Analysis

Incidence and Risk Factors of Intraoperative Adverse Events During Donor Lobectomy for Living-Donor Liver Transplantation: A Retrospective Analysis

Blood conservation strategies in orthopedic surgeries: A review

Transfusion of autologous blood

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