Open heart surgery in children of Jehovah's witnesses: Extreme hemodilution on cardiopulmonary bypass

Stein, J.; Gombotz, Hans; Rigler, B; Metzler, H.; Suppan, Christoph; Beitzke, A

doi:10.1007/bf02238525

Cited by 43 publications

(22 citation statements)

References 17 publications

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“…Experience with children of members of the Jehovah Witness faith in two centres did not report any increase in the incidence of postoperative neurological deficits. 6s, 69 Henling et al 68 reviewed the perioperative courses of 110 children of members of the Jehovah Witness faith who underwent cardiac surgery during normothermic cardiopulmonary bypass with a glucose cl3rstalloid prime. These children ranged in age from six months to 12 yr mad weighed 5.2 to 42.3 kg.…”

Section: Haemodilutionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral physiology in paediatric cardiopulmonary bypass

Pua

Bissonnette

1998

Can J Anaesth

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FKCPCPurpose: To analyze studies of neurological injury after open-heart surgery in infants and children and to discuss the effects of cardiopulmonary bypass, hypothermia and deep hypothermic circulatory arrest on cerebral blood flow, cerebral metabolism and brain temperature. Source: Articles were obtained from the databases, Current Science and Medline, from 1966 to present. Search terms include cardiopulmonary bypass(CPB), hypothermia, cerebral blood flow(CBF), cerebral metabolism and brain temperature. Information and abstracts obtained from meetings on the topic of brain and cardiac surgery helped complete the collection of information. Principal findings: In adults the incidence of neurological morbidity is between 7 to 87% with stroke in about 2-5%, whereas the incidence of neurological morbidity increases to 30% in infants and children undergoing cardiopulmonary bypass. Besides the medical condition of the patient, postoperative cerebral dysfunction and neuronal ischaemia associated with cardiac surgery in infants and small children are a combination of intraoperative factors. Deep hypothermic circulatory arrest impairs CBF and cerebral metabolism even after termination of CPB. Inadequate and/or non-homogenous cooling of the brain before circulatory arrest, as well as excessive rewarming of the brain during reperfusion are also major contributory factors. Conclusion: Newer strategies, including the use of low-flow CPB, pulsatile CPB, pH-stat acid-base management and a cold reperfusion, are being explored to ensure better cerebral protection, Advances in monitoring technology and better understanding of the relationship of cerebral blood flow and metabolism during the different modalities of cardiopulmonary bypass management will help in the medical and anaesthetic development of strategies to improve neurological and developmental outcomes.Objectif: Examiner les Etudes portant sur les atteintes neurologiques survenues apr& une chirurgie b. coeur ouvert chez les bEbEs et les enfants et discuter des effets de la circulation extracorporelle, de l'hypothermie et de l'arr~t circulatoire sous hypothermie profonde sur le debit sanguin c&~bral, sur le m&abolisme c&Ebral et sur la temperature du cerveau. Sources documentaires : Des articles ont &E choisis ~ partir de bases de donnEes, Current Science et Medline, de 1966 ~ aujourd'hui. Les mots-cl& utilis& Etaient : circulation extracorporelle (CEC), hypothermie, debit sanguin cErEbral (DSC), mEtabolisme cErEbral et temperature du cerveau. Les informations et les rEsumEs obtenus & la suite de sEminaires sur le cerveau et la chirurgie cardiaque ont permis de completer la cueillette de donn&s. I)onn&s principales : Chez les adultes, l'incidence de morbiditE neurologique avec accident vasculaire est de 7 87 % clans 2 ~. S % des cas tandis que l'incidence de morbiditE neurologique augmente & 30 % chez les bEb~s et les enfants subissant une circulation extracorporelle. La condition mEdicale du patient raise & part, le d&~glement cErEbral postop&atoire et l'ischEmie neu...

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Section: Haemodilutionmentioning

confidence: 99%

“…Stein et al 69 reported the use of a modified version of isovolaemic haemodilution and a bloodless prime technique during moderate to profound hypothermic CPB or total circulatory arrest in 15 children of Jehovah Witnesses, aged between 1.5 and 17 yr. Mean haematocrit levels achieved during bypass was 17.9%.…”

Section: Haemodilutionmentioning

confidence: 99%

Cerebral physiology in paediatric cardiopulmonary bypass

Pua

Bissonnette

1998

Can J Anaesth

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“…1 The endovascular treatment of aortic disease has emerged as an alternative for patients with severe comorbid disease, who are not good candidates for open surgery. [6][7][8] Acute type-B aortic dissection is usually treated medically with vasodilators and -blockers; however, aneurysmal dilatation of the dissected aorta eventually occurs in 14%-20% of these patients.…”

Section: Discussionmentioning

confidence: 99%

“…The religious belief of Jehovah's Witnesses, based on their interpretation of the Bible (Genesis 9:3-6, Leviticus 17:10, and Acts 15:28,29), forbids the transfusion of homologous blood products. 1 The surgical treatment of cardiac disease in this population is well documented worldwide, 2-5 but there is still limited clinical experience in treating Jehovah's Witnesses with thoracic aneurysms. 4,5 Thoracic aortic aneurysm repair often requires the transfusion of large quantities of blood products; however, blood conservation tech- artery.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Stent Grafting for Thoracic Aneurysms in Jehovah?s Witnesses: Report of Three Cases

et al. 2005

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There are few published reports on endovascular stent grafting for thoracic aneurysms in Jehovah's Witnesses. Between 2001 and 2003, we performed endovascular stent grafting for a thoracic aneurysm in three patients of the Jehovah's Witness faith. Two patients had a thoracic aortic aneurysm and one had a chronic type-B dissection. The stent graft was constructed from a self-expanding Z-stent and thin-walled woven polyester fabric. None of the patients required perioperative blood transfusion, there was no postoperative endoleak, and all recovered uneventfully and were discharged from hospital. Thus, stent-graft repair of thoracic aneurysms in Jehovah's Witnesses is feasible and can be achieved without the need for blood transfusion.

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“…There was one death related to persistent pulmonary hypertension (27). To revert hemodilution after CPB, modified ultrafiltration has been used (28,29).…”

Section: Introductionmentioning

confidence: 99%

First Use of Hypertonic Saline Dextran in Children: A Study in Safety and Effectiveness for Atrial Septal Defect Surgery

Rocha-e-Silva

Canêo²,

Filho³

et al. 2003

Shock

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Hypertonic saline dextran (7.5% NaCl + 6% Dextran-70) has been used in adults in several studies and shown beneficial effects in hypovolemic shock, trauma, cardiogenic shock, and cardiac surgery. There have never been studies of this solution in children. This work studies its effect in children undergoing surgery for the correction of atrial septal defects. Twenty-five children underwent correction of atrial septal defect using cardiopulmonary bypass with bloodless priming. Children were divided in five groups and each received an incremental hypertonic saline dextran dose of 0.1, 0.5, 1.0, 2.0, and 4.0 mL/kg, 5 min before the beginning of cardiopulmonary bypass. Collected data were fluid balance, amount of bleeding, blood/derivative transfusion occurrence, plasma sodium, and hematocrit. Patients were divided into low-dose (0-1 mL/kg) and high-dose (2-4 mL/kg) groups. Analysis of variance was used to determine differences in blood loss between groups. The fluid balance and blood/derivative requirements were compared through Student's t test and Fisher's exact test (2-tail), respectively. All patients were discharged from hospital with corrected atrial septal defect. No hypertonic saline dextran-related complications occurred. There were no differences in the amount of bleeding. The high-dose group exhibited a significant decrease in fluid balance and in blood/derivative requirements in comparison with the low-dose group. In this study, the use of hypertonic saline dextran in the pediatric population submitted to cardiopulmonary bypass is safe and does not raise the amount of bleeding. Its effective doses produce negative fluid balance and reduce blood/derivative requirements.

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Open heart surgery in children of Jehovah's witnesses: Extreme hemodilution on cardiopulmonary bypass

Cited by 43 publications

References 17 publications

Cerebral physiology in paediatric cardiopulmonary bypass

Cerebral physiology in paediatric cardiopulmonary bypass

Endovascular Stent Grafting for Thoracic Aneurysms in Jehovah?s Witnesses: Report of Three Cases

First Use of Hypertonic Saline Dextran in Children: A Study in Safety and Effectiveness for Atrial Septal Defect Surgery

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