Use of Intravenous Premarin to Decrease Postoperative Blood Loss After Pediatric Scoliosis Surgery

McCall, Richard E.; Bilderback, Karl

doi:10.1097/00007632-199706150-00019

Cited by 18 publications

(9 citation statements)

References 5 publications

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“…41 In another study, the use of conjugated oestrogens was associated with a 37% reduction in postoperative bleeding after paediatric scoliosis surgery. 94 Conjugated oestrogens are well tolerated and side-effects are negligible or absent. Since no more than five to seven daily doses are recommended, adverse effects due to oestrogenic hormonal activity are usually avoided.…”

Section: Conjugated Oestrogensmentioning

confidence: 99%

Perioperative systemic haemostatic agents

Mahdy

Webster

2004

British Journal of Anaesthesia

154

117

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Skilful surgery combined with blood-saving methods and careful management of blood coagulation will all help reduce unnecessary blood loss and transfusion requirements. Excessive surgical bleeding causes hypovolaemia, haemodynamic instability, anaemia and reduced oxygen delivery to tissues, with a subsequent increase in postoperative morbidity and mortality. The role of anaesthetists in managing surgical blood loss has increased greatly in the last decade. Position of the patient during surgery and the provision of a hypotensive anaesthetic regimen were once considered the most important contributions of the anaesthetist to decreasing blood loss. Now, several pharmacological haemostatic agents are being used by anaesthetists as blood-saving agents. After a brief discussion of the physiology of haemostasis, this article will review the evidence for the role of such agents in reducing perioperative blood loss and transfusion requirements.

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Section: Conjugated Oestrogensmentioning

confidence: 99%

Perioperative systemic haemostatic agents

Mahdy

Webster

2004

British Journal of Anaesthesia

154

117

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Section: Introductionmentioning

confidence: 99%

“…The most common include drug therapy (desmopressin [2,58], aprotinin [25,85], tranexamic acid [27,65], hypotensive anaesthesia [59,83], and autotransfusion techniques, such as normovolemic acute hemodilution [14,19,56,67], perioperative salvage [3,28,56], postoperative salvage and autologous blood donation (ABD) [39,49,57,64,80,88]. During the 1990s a new drug, recombinant human erythropoietin (rHuEPO), was added to the repertory of blood-conservation techniques [6,9,32,33,73].…”

Section: Introductionmentioning

confidence: 99%

“…Extensive bleeding may lead to rapid fatal consequences and to risks associated with allogenic blood transfusion [4, 8, 36,40,81]. Measures should be taken to minimise these risks [18, 26,50,58,64,65,66,68,79].Over the last 30 years, considerable efforts have been made to develop new blood-conservation strategies that Abstract Spine surgery may be associated with profuse intraoperative bleeding that often requires blood transfusions. In recent years several techniques have been developed to avoid allogenic transfusions and their potential complications to surgical patients.…”

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confidence: 99%

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Preoperative erythropoietin in spine surgery

et al. 2004

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IntroductionSurgery for spinal deformities or degenerative lumbar disease may be associated with blood loss ranging from 30% to 100% of the patient's total blood volume [18, 26,68,79,85,87]. This loss of blood is related to the complexity of the procedure, duration of surgery, number of fused levels, anaesthetic technique and the patient's comorbid conditions [18, 26,68,76,79,85,87]. Extensive bleeding may lead to rapid fatal consequences and to risks associated with allogenic blood transfusion [4, 8, 36,40,81]. Measures should be taken to minimise these risks [18, 26,50,58,64,65,66,68,79].Over the last 30 years, considerable efforts have been made to develop new blood-conservation strategies that Abstract Spine surgery may be associated with profuse intraoperative bleeding that often requires blood transfusions. In recent years several techniques have been developed to avoid allogenic transfusions and their potential complications to surgical patients. In this study we review and analyse the role of preoperative recombinant human erythropoietin (rHuEPO) administration in spine surgery as a blood conservation strategy. Between 1998 and 2002, a total of 250 patients scheduled for spine surgery were included in our bloodsparing program: 114 patients (group 1), operated on before rHuEPO approval (2000), underwent preoperative autologous blood donation (ABD) alone, and 136 patients operated on after rHuEPO approval (groups 2 and 3) received rHuEPO while undergoing ABD. Adding rHuEPO to ABD resulted in higher haemoglobin and haematocrit values the day of surgery, more ABD units retrieved per patient and, consequently, reduced allogenic transfusion requirements. The effectiveness of rHuEPO as the only preoperative blood conservation technique was evaluated in ten patients with a predicted blood loss of less than 30% of their total volume, scheduled for lumbar surgery. Data from these patients were matched with those from a similar group of patients who had undergone ABD. Patients receiving rHuEPO alone had higher haemoglobin levels the day of surgery than did patients in the ABD program. Neither group required allogenic transfusions. Conclusions: preoperative rHuEPO is useful for reducing allogenic blood requirements in elective spine surgery. In patients with an expected blood loss of around 50% of blood volume, rHuEPO improves ABD, minimising preoperative anaemia and increasing the number of ABD units collected. In patients with expected blood loss below 30% of total volume, rHuEPO administration may replace ABD.

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“…In a controlled study McCall et al [86] have reported the efficacy of conjugated oestrogens (Premarin, WyethAyerst) in decreasing the postoperative drainage volume in adolescents having undergone deformity surgery. There were no side effects.…”

Section: Oestrogens: Estriol Conjugated Oestrogensmentioning

confidence: 99%