Massive Blood Replacement in Neonates and Children

Abstract

Seventeen neonates and small children underwent the operation of wedge excision spinal osteotomy for the correction of gross kyphosis. The operation involved massive blood loss, exceeding 50 per cent of estimated blood volume in all patients, and exceeding 150 per cent in two, with no operative mortality. The anaesthetic technique and management of massive blood replacement in these cases is described. The general problems associated with massive blood transfusion in small subjects are reviewed and discussed. Maintenance of normothermia, and replacement of measured loss with warmed fresh blcod with buffering of the acid load are amongst the main recommendations.

A New Blood Warmer

“…There have been several reviews of the hazards of massive blood transfusion (Baue, Herman and Shaw, 1961;Bennett, 1968;Besseling et al, 1965 These controls must always be checked before blood is transfused. Bendixen and Murphy, 1962;Burton, 1968;Churchill-Davidson, 1968;Dybkjaer and Elkjaer, 1964;Hey, Kohlinsky and O'Connell, 1969;Ludbrook and Wynn, 1958;Mollison, 1972;Schroeder and Forbes, 1969). Cold stored blood (4-8 °C) should never be transfused rapidly as this may cause a serious decrease in the temperature of the recipient, particularly in the anaesthetized infant (Dybkjaer and Elkjaer, 1964;Harrison, Bull and FIG.…”

The Importance of Changes in Body Temperature in Paediatric Surgery and Anaesthesia

“…The problems of massive blood transfusion in adults have been discussed by Boyan and Howland (1961) and by Churchill-Davidson, Burton and Bennett (1968). Schroeder and Forbes (1969) discussed massive blood replacement in neonates and infants. Hey, Kohlinsky and O'Connell (1969) measured the heat loss from babies during exchange transfusion, which can be regarded as a form of massive transfusion if the definition of replacement of half the patient's blood volume in an hour (Stewart 1962) is accepted.…”

“…anticoagulant, when compared with A.C.D., confers benefits of a higher pH, better red cell survival and function, and a somewhat smaller potassium leak from cells (Mollison] 972). While the routine use of calcium gluconate is still recommended by Burton (1968) and Schroeder and Forbes (1969), the author of this paper has been impressed both with the infrequency of clinical indications for its use and the occasional adverse effects (Howland, Schweitzer and Boyan 1964;Brine 1972). The routine use of sodium bicarbonate during massive infusions, especially if tissue perfusion is inadequate, is more rational.…”