Blood-Saving Techniques in Surgery
Keywords:
Blood transfusion, morbidity, blood transfusion, autologous, perioperative period.
Abstract
Introduction. Blood transfusions are tissue transplants with morbimortality and costs involved.
Methodology. A description of the strategies consistent with the current literature that offers a review of de last decade.
Results and Conclusions. We have to deal with elderly patients with comorbidities who will undergo complex procedures. Blood transfusions must be streamlined, thorugh the development of technical protocols, improving the patient’s condition, decreasing operative blood loss, recovering any blood losses and establishing an institutional program for autologous blood donation.
References
1. Goodnough LT. Risks of blood transfusion. Crit Care Med. 2003;31:(Suppl)S678-86.
2. Hébert PC. Clinical consequences of anemia and red cell. Crit Care Clin. 2004;20:225-35.
3. Verma S, Eisses M, Ricards M. Blood conservation strategies in pediatric anesthesia. Anesthesiol Clin. 2009;29:337-51.
4. Ferrer A. Medicina Transfusional. Madrid: Ed. Médica Panamericana; 2009.
5. Keating EM. Preoperative evaluation and methods to reduce blood use in orthopedic surgery. Anesthesiol Clin North America. 2005;23:305-13.
6. Madjdpour C, Heindl V, Spahn DR. Risks, benefits, alternatives and indications of allogenic blood transfusion. Minerva Anestesiol. 2006;72:283-98.
7. Goodnough LT, Shander A, Spivak JL, et al. Detection, evaluation and management of anemia in the elective surgical patient. Anesth Analg. 2005;101:1858-61.
8. Cook J.D. Diagnosis and management of iron-deficiency anaemia. Best Pract Res Clin Haematol. 2005;18:319-32.
9. Ganzoni AM. Intravenous iron-dextran: Therapeutic and experimental possibilities. Schweiz Med Wochenschr. 1970;100:301-3. [Artículo en alemán].
10. Beris P. The use of iron to increase red cell mass. Can J Anesth. 2003;50(6 Suppl):S3-9.
11. Madrazo González Z, García Barrasa A, Rodríguez Lorenzo L, et al. Hierro Intravenoso. Cir Esp. 2009;86:196-203.
12. Kendoff D, Tomeczkowski J, Gombotz H, et al. Preoperative anemia in orthopedic surgery: Clinical impact, dianostics and teatmente. Orthopade. 2011, Sep 17 (Epub ahead of print).
13. Hébert PC, Blajchman MA, Cook DJ, et al. Do blood transfusions improve outcomes related to mechanical ventilation? Chest. 2001;119:1850-7.
14. Freeman S, DeVita M. et al. Randomized controlled trials are needed to determine appropriate blood transfusion strategies in patients with acute coronary syndromes. 2005;9:e6.
15. Rao SV, Jollis JG, Harrington RZ, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA. 2004;292:1555-62.
16. Shander A. Anemia in the critically ill. Crit Car Clin. 2004;159-68.
17. Izuel Rami M, Gómez Barrera M, Villar Fernández I, et al. Análisis del impacto presupuestario de la implantación de medidas de ahorro de sangre en cirugía de urgencia. Med Clin (Barcelona). 2007;128:7-11.
18. Kuriyan M, Carson JL. Anemia and clinical outcomes. Anhestesiol Clin North America. 2005;23:315-25.
19. Lacroix J, Hábert PC, Hutchinson JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;356:1609-19.
20. Fields RG, Gencorelli FJ, Litman RS. Anesthetic management of the pediatric bleending tonsil. Pediatr Anaesth. 2010;20:982-6.
21. American Society of Anesthesiologists. Practice Guidelines for Perioperative Blood Transfusion. Anesthesiology 2006;(105):198-208.
22. Santora RJ, Moore FA. Monitoring trauma and intensive care unit resuscitation with tissue hemoglobin oxygen saturation. Crit Care. 2009;13(Suppl 5):S10.
23. Bilkovski RN, Rivers EP, Horst HM. Targeted resuscitation strategies after injury. Curr Opin Crit Care. 2004;10:529-38.
24. Napolitano LM. Resuscitation endpoints in trauma. TATM. 2005;6:8-14.
25. García MJ. Pérdidas sanguíneas permisibles, modelo exponencial. Rev. Colomb. Anestesiol. 2009;37:255-62.
26. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007;356:2301-11.
27. British Committee for Standards in Haematology, Stainsby D, MacLennan S, et al. Guidelines on the management of massive blood loss. Br J Haematol. 2006;135:634-41.
28. Hahn RG. Volume kinetics for infusion fluids. Anesthesiology. 2010;113:470-81.
29. Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723-40.
30. Ahonen J, Stefanovic V, Lassila R. Management of post-partum haemorrhage. Acta Anaesthesiol Scand. 2010;54:1164-78.
31. Levi M, Levy JH, Andersen HF, et al. Safety of recombinant activated factor VII in randomized clinical trials. N Engl J Med. 2010;363:1791-800.
32. McLintock C. Obstetric haemorrhage. Thromb Res. 2009;123(Suppl 2):S30-4.
33. Breathnach F, Geary M. Uterine atony: definition, prevention, nonsurgical management, and uterine tamponade. Semin Perinatol. 2009;33:82-7.
34. Burtelow M, Riley E, Druzin M, et al. How we treat: management of life-threatening primary postpartum hemorrhage with a standardized massive transfusion protocol. Transfusion. 2007;47:1564-72.
35. Aledort LM. Off-label use of recombinant activated factor VII - safe or not safe? N Engl J Med. 2010;363:1853-4.
36. Hause CJ, Boffard K, Dutton R, et al. Results of the control trial: efficacy and safety of recombinant activated factor VII in the management of refractory traumatic hemorrhage. J Trauma. 2010;69:489-500.
37. Schick KS, Fertmann JM, Jauch KW, et al. Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding. Crit Care. 2009;13:R191.
38. Leissinger CA, Blatt PM, Hoots WK, et al. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol. 2008;83:137-43.
39. CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096-101.
40. Henry D, Carless P, Fergusson D, et al. The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis. CMAJ. 2009;180:183-93.
41. Ozgönenel B, Rajpurkar M, Lusher JM. How do you treat bleeding disorders with desmopressin? Postgrad Med J. 2007;83:159-63.
42. McEvoy MD, Reeves ST, Reves JG, et al. Aprotinin in cardiac surgery: a review of conventional and novel mechanisms of action. Anesth Analg. 2007;105:949-62.
43. Purdham RS. Reduced blood loss with hemodynamic stability during controlled hypotensive anesthesia for Lefort I maxillary osteotomy using high dose fentanyl: a retrospective study. CRNA. 1996;7:33-46.
44. Carrillo-Esper R, Sánchez-García R. Coagulopatía dilucional. Revista Mexicana de Anestesiología. 2008; 31Supl 1:S129-31.
45. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998;85:1058-60.
46. Scott NB, Kehlet H. Regional anaesthesia and surgical morbidity. Br J Surg. 1988;75:299-304.
47. Schonauer C, Bocchetti A, Barbagallo G, et al. Positioning on surgical table. Eur Spine J. 2004;13(Suppl 1):S50-5.
48. Jiménez JCE. Recomendaciones medicoquirúrgicas para disminuir el uso y pérdida de derivados sanguíneos. Rev Colomb Cir. 2005;20:105-17.
49. Kragh JF, O Neill ML, Beebe DF, et al. Survey of the indications for use of emergency tourniquets. J Spec Oper Med. 2011;11:30-8.
50. Perkins JG, Cap AP, Weiss BM, et al. Massive transfusion and nonsurgical hemostatic agents. Crit Care Med. 2008;36(7 Suppl):S325-39.
51. Spahn DR, Casutt M. Eliminating blood ttransfusions: new aspects and perspective. Anesthesiology. 2000;93:242-55.
52. Goodnough LT. Autologous blood donation. Anestesiol Clin North America. 2005;23:263-70.
53. Napier JA, Bruce M, Chapman J, et al. Guidelines for autologus transfusion II. Perioperative haemodilution and cell salvage. Br J Anaesth. 1997;78:768-71.
54. Bisbe E, Sáez M, Nomen N, et al. Eritropoyetina sólo o como coadyuvante del programa de donación de sangre autóloga en cirugía ortopédica mayor. Rev Esp Anestesiol Reanim. 2003;50:395-400.
55. Singbartl K, Innerhofer P, Radvan J, et al. Hemostasis and hemodilution: a quantitative mathematical guide for clinical practice. Anesth Analg. 2003;96:929-35.
56. Singbartl G. Pre-operative autologous blood donation: clinical parameters and efficacy. Blood Transfus. 2011;9:10-8.
57. Brecher ME, Rosenfeld M. Mathematical and computer modelling of acute normovolemic hemodilution. Transfusion. 1994;34:176-9.
58. Muñoz Gómez M, Naveira Abeigón E, Campos Garrigues A, et al. Usefulness of autologous transfusion and erythropoietin in surgical and critically ill patients. Med Clin (Barc). 2003;120:357-8.
59. Muñoz M, Leal Noval SR, García Erce JA. ¿Eritropoyetina humana recombinante, ¿Una alternativa válida para el tratamiento de la anemia del paciente crítico? Med Clin (Barc). 2009;132:749-55.
60. van der Linden P, De Hert S, Mathieu N, et al. Tolerance of acute isovolemic hemodilution. Effect of anesthetic depth. Anesthesiology. 2003;99:97-104.
61. Bourke DL, Smith TC. Estimating allowable hemodilution. Anesthesiology. 1974;41:609-12.
62. Bryson GL, Laupacis A, Wells GA. Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion? A metaanalysis. The International Study of Perioperative Transfusion. Anesth Analg. 1998;86:9-15.
63. Jiménez DF, Barone CM. Intraoperative autologous blood transfusion in the surgical correction of craniosynostosis. Neurosurgery. 1995;37:1075-9.
64. Waters JH. Red blood cell recovery and reinfusion. Anestesiol Clin North America. 2005;23:283-94.
65. Schaff HV, Hauer JM, Bell WR, et al. Autotrasfusion of shed mediastinal blood after cardiac surgery: a prospective study. J Thorac Cardiovasc Surg. 1978;75:632-41.
66. Muñoz Gómez M, García Vallejo J, López-Andrade Jurado A, et al. Autotrasfusion after orthopedic surgery: Analysis of quality, safety and efficacy of salvaged shed blood. Rev Esp Anestesiol Reanim. 2001;48:131-40.
67. Bhanji F, Mancini ME, Sinz E, et al. Part 16: education, implementation, and teams: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.
2. Hébert PC. Clinical consequences of anemia and red cell. Crit Care Clin. 2004;20:225-35.
3. Verma S, Eisses M, Ricards M. Blood conservation strategies in pediatric anesthesia. Anesthesiol Clin. 2009;29:337-51.
4. Ferrer A. Medicina Transfusional. Madrid: Ed. Médica Panamericana; 2009.
5. Keating EM. Preoperative evaluation and methods to reduce blood use in orthopedic surgery. Anesthesiol Clin North America. 2005;23:305-13.
6. Madjdpour C, Heindl V, Spahn DR. Risks, benefits, alternatives and indications of allogenic blood transfusion. Minerva Anestesiol. 2006;72:283-98.
7. Goodnough LT, Shander A, Spivak JL, et al. Detection, evaluation and management of anemia in the elective surgical patient. Anesth Analg. 2005;101:1858-61.
8. Cook J.D. Diagnosis and management of iron-deficiency anaemia. Best Pract Res Clin Haematol. 2005;18:319-32.
9. Ganzoni AM. Intravenous iron-dextran: Therapeutic and experimental possibilities. Schweiz Med Wochenschr. 1970;100:301-3. [Artículo en alemán].
10. Beris P. The use of iron to increase red cell mass. Can J Anesth. 2003;50(6 Suppl):S3-9.
11. Madrazo González Z, García Barrasa A, Rodríguez Lorenzo L, et al. Hierro Intravenoso. Cir Esp. 2009;86:196-203.
12. Kendoff D, Tomeczkowski J, Gombotz H, et al. Preoperative anemia in orthopedic surgery: Clinical impact, dianostics and teatmente. Orthopade. 2011, Sep 17 (Epub ahead of print).
13. Hébert PC, Blajchman MA, Cook DJ, et al. Do blood transfusions improve outcomes related to mechanical ventilation? Chest. 2001;119:1850-7.
14. Freeman S, DeVita M. et al. Randomized controlled trials are needed to determine appropriate blood transfusion strategies in patients with acute coronary syndromes. 2005;9:e6.
15. Rao SV, Jollis JG, Harrington RZ, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA. 2004;292:1555-62.
16. Shander A. Anemia in the critically ill. Crit Car Clin. 2004;159-68.
17. Izuel Rami M, Gómez Barrera M, Villar Fernández I, et al. Análisis del impacto presupuestario de la implantación de medidas de ahorro de sangre en cirugía de urgencia. Med Clin (Barcelona). 2007;128:7-11.
18. Kuriyan M, Carson JL. Anemia and clinical outcomes. Anhestesiol Clin North America. 2005;23:315-25.
19. Lacroix J, Hábert PC, Hutchinson JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;356:1609-19.
20. Fields RG, Gencorelli FJ, Litman RS. Anesthetic management of the pediatric bleending tonsil. Pediatr Anaesth. 2010;20:982-6.
21. American Society of Anesthesiologists. Practice Guidelines for Perioperative Blood Transfusion. Anesthesiology 2006;(105):198-208.
22. Santora RJ, Moore FA. Monitoring trauma and intensive care unit resuscitation with tissue hemoglobin oxygen saturation. Crit Care. 2009;13(Suppl 5):S10.
23. Bilkovski RN, Rivers EP, Horst HM. Targeted resuscitation strategies after injury. Curr Opin Crit Care. 2004;10:529-38.
24. Napolitano LM. Resuscitation endpoints in trauma. TATM. 2005;6:8-14.
25. García MJ. Pérdidas sanguíneas permisibles, modelo exponencial. Rev. Colomb. Anestesiol. 2009;37:255-62.
26. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007;356:2301-11.
27. British Committee for Standards in Haematology, Stainsby D, MacLennan S, et al. Guidelines on the management of massive blood loss. Br J Haematol. 2006;135:634-41.
28. Hahn RG. Volume kinetics for infusion fluids. Anesthesiology. 2010;113:470-81.
29. Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723-40.
30. Ahonen J, Stefanovic V, Lassila R. Management of post-partum haemorrhage. Acta Anaesthesiol Scand. 2010;54:1164-78.
31. Levi M, Levy JH, Andersen HF, et al. Safety of recombinant activated factor VII in randomized clinical trials. N Engl J Med. 2010;363:1791-800.
32. McLintock C. Obstetric haemorrhage. Thromb Res. 2009;123(Suppl 2):S30-4.
33. Breathnach F, Geary M. Uterine atony: definition, prevention, nonsurgical management, and uterine tamponade. Semin Perinatol. 2009;33:82-7.
34. Burtelow M, Riley E, Druzin M, et al. How we treat: management of life-threatening primary postpartum hemorrhage with a standardized massive transfusion protocol. Transfusion. 2007;47:1564-72.
35. Aledort LM. Off-label use of recombinant activated factor VII - safe or not safe? N Engl J Med. 2010;363:1853-4.
36. Hause CJ, Boffard K, Dutton R, et al. Results of the control trial: efficacy and safety of recombinant activated factor VII in the management of refractory traumatic hemorrhage. J Trauma. 2010;69:489-500.
37. Schick KS, Fertmann JM, Jauch KW, et al. Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding. Crit Care. 2009;13:R191.
38. Leissinger CA, Blatt PM, Hoots WK, et al. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol. 2008;83:137-43.
39. CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096-101.
40. Henry D, Carless P, Fergusson D, et al. The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis. CMAJ. 2009;180:183-93.
41. Ozgönenel B, Rajpurkar M, Lusher JM. How do you treat bleeding disorders with desmopressin? Postgrad Med J. 2007;83:159-63.
42. McEvoy MD, Reeves ST, Reves JG, et al. Aprotinin in cardiac surgery: a review of conventional and novel mechanisms of action. Anesth Analg. 2007;105:949-62.
43. Purdham RS. Reduced blood loss with hemodynamic stability during controlled hypotensive anesthesia for Lefort I maxillary osteotomy using high dose fentanyl: a retrospective study. CRNA. 1996;7:33-46.
44. Carrillo-Esper R, Sánchez-García R. Coagulopatía dilucional. Revista Mexicana de Anestesiología. 2008; 31Supl 1:S129-31.
45. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998;85:1058-60.
46. Scott NB, Kehlet H. Regional anaesthesia and surgical morbidity. Br J Surg. 1988;75:299-304.
47. Schonauer C, Bocchetti A, Barbagallo G, et al. Positioning on surgical table. Eur Spine J. 2004;13(Suppl 1):S50-5.
48. Jiménez JCE. Recomendaciones medicoquirúrgicas para disminuir el uso y pérdida de derivados sanguíneos. Rev Colomb Cir. 2005;20:105-17.
49. Kragh JF, O Neill ML, Beebe DF, et al. Survey of the indications for use of emergency tourniquets. J Spec Oper Med. 2011;11:30-8.
50. Perkins JG, Cap AP, Weiss BM, et al. Massive transfusion and nonsurgical hemostatic agents. Crit Care Med. 2008;36(7 Suppl):S325-39.
51. Spahn DR, Casutt M. Eliminating blood ttransfusions: new aspects and perspective. Anesthesiology. 2000;93:242-55.
52. Goodnough LT. Autologous blood donation. Anestesiol Clin North America. 2005;23:263-70.
53. Napier JA, Bruce M, Chapman J, et al. Guidelines for autologus transfusion II. Perioperative haemodilution and cell salvage. Br J Anaesth. 1997;78:768-71.
54. Bisbe E, Sáez M, Nomen N, et al. Eritropoyetina sólo o como coadyuvante del programa de donación de sangre autóloga en cirugía ortopédica mayor. Rev Esp Anestesiol Reanim. 2003;50:395-400.
55. Singbartl K, Innerhofer P, Radvan J, et al. Hemostasis and hemodilution: a quantitative mathematical guide for clinical practice. Anesth Analg. 2003;96:929-35.
56. Singbartl G. Pre-operative autologous blood donation: clinical parameters and efficacy. Blood Transfus. 2011;9:10-8.
57. Brecher ME, Rosenfeld M. Mathematical and computer modelling of acute normovolemic hemodilution. Transfusion. 1994;34:176-9.
58. Muñoz Gómez M, Naveira Abeigón E, Campos Garrigues A, et al. Usefulness of autologous transfusion and erythropoietin in surgical and critically ill patients. Med Clin (Barc). 2003;120:357-8.
59. Muñoz M, Leal Noval SR, García Erce JA. ¿Eritropoyetina humana recombinante, ¿Una alternativa válida para el tratamiento de la anemia del paciente crítico? Med Clin (Barc). 2009;132:749-55.
60. van der Linden P, De Hert S, Mathieu N, et al. Tolerance of acute isovolemic hemodilution. Effect of anesthetic depth. Anesthesiology. 2003;99:97-104.
61. Bourke DL, Smith TC. Estimating allowable hemodilution. Anesthesiology. 1974;41:609-12.
62. Bryson GL, Laupacis A, Wells GA. Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion? A metaanalysis. The International Study of Perioperative Transfusion. Anesth Analg. 1998;86:9-15.
63. Jiménez DF, Barone CM. Intraoperative autologous blood transfusion in the surgical correction of craniosynostosis. Neurosurgery. 1995;37:1075-9.
64. Waters JH. Red blood cell recovery and reinfusion. Anestesiol Clin North America. 2005;23:283-94.
65. Schaff HV, Hauer JM, Bell WR, et al. Autotrasfusion of shed mediastinal blood after cardiac surgery: a prospective study. J Thorac Cardiovasc Surg. 1978;75:632-41.
66. Muñoz Gómez M, García Vallejo J, López-Andrade Jurado A, et al. Autotrasfusion after orthopedic surgery: Analysis of quality, safety and efficacy of salvaged shed blood. Rev Esp Anestesiol Reanim. 2001;48:131-40.
67. Bhanji F, Mancini ME, Sinz E, et al. Part 16: education, implementation, and teams: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.
How to Cite
1.
Rivera Tocancipá D, Pérez Ferrer A. Blood-Saving Techniques in Surgery. Colomb. J. Anesthesiol. [Internet]. 2011 Oct. 1 [cited 2024 Apr. 25];39(4):545-59. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/643
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2011-10-01
How to Cite
1.
Rivera Tocancipá D, Pérez Ferrer A. Blood-Saving Techniques in Surgery. Colomb. J. Anesthesiol. [Internet]. 2011 Oct. 1 [cited 2024 Apr. 25];39(4):545-59. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/643
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