Regional Lung Function Following Hip Arthroplasty and Preoperative Normovolemic Hemodilution

Abstract

The effect of preoperative normovolemic hemodilution with dextran 70 as dilutional agent on postoperative regional lung function was evaluated in patients undergoing hip arthroplasty in the lateral decubitus position. The major part of the surgical blood loss of these patients was replaced with the received autologous blood. The results obtained were compared to changes in a group of patients in whom the operative bleeding was replaced with bank blood. Regional lung function, as studied with Xe133 radiospirometry, is not negatively influenced by the hemodilution technique. In both groups a reduction in perfusion, ventilation and volume of ventilated alveoli was revealed postoperatively in the lung that was dependent during surgery, probably caused by impaired ventilation of this lung and peroperatively induced microembolism. A more rapid normalization was found in the preoperatively hemodiluted patients. The reduced volume of bank blood transfused to these patients and/or a protective effect of the preoperatively infused dextran on the microembolism evoked by the surgical trauma might explain this difference between the groups studied.

A Randomized Trial of Acute Normovolemic Hemodilution Compared to Preoperative Autologous Blood Donation in Total Knee Arthroplasty

“…The allogeneic transfusion rates were 2 (12.5%), 1 (6.25%), 8 (50%), and 10 (67%), respectively, indicating that ANH was as effective as PAD, and that both were superior to autologous blood salvage alone [20]. Some additional clinical studies in other surgical settings are summarized in table 6 [25, 26, 27, 28, 29, 30]. However, none of these reports studied the effect of ANH in total knee arthroplasty.…”

Perioperative Autologous Blood Transfusion in Elective Total Hip Prosthesis Operations

“…Correspondence to: Dr S R Bennett FFARCS, Thoraxkliniken, Norrlands University Hospital, Umea 901-85, Sweden for many years have suggested that haemodilution is not only safe in selected patients, including the elderly (10)(11)(12)(13)(14), but have gone on to demonstrate an 'optimum haematocrit' in the surgical patient (15). The lack of adverse cardiovascular and respiratory side-effects during haemodilution has been well documented (16,17).…”

Acceptable hematocrit levels in surgical patients

“…If necessary, the hematocrit should be adjusted at the end of surgery to a level of about 30%, i.e., the values for patients undergoing preoperative hemodilution. In addition to the studies reviewed previously [10], more recent reports in the literature on pre-and intraoperative hemodilution confirm that hematocrit values of 27-30% are safely tolerated by patients undergoing general surgery [39], thoracic surgery [40], vascular, coronary, and open-heart surgery [29,[41][42][43][44][45][46], liver and tremor resection in children [47,48], orthopedic surgery and total hip replacement [39,[49][50][51][52], orthopedic surgery in children [52,53], and neurosurgery [54].…”