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Li W, Li X, Chen Y, Li Y, Chen R, Kang Z, Huang Z, Zhao Y. Effects of acute normovolemic hemodilution and allogeneic blood transfusion on postoperative complications of oral and maxillofacial flap reconstruction: a retrospective study. BMC Oral Health 2024; 24:606. [PMID: 38789959 PMCID: PMC11127284 DOI: 10.1186/s12903-024-04302-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE Patients undergoing oral and maxillofacial flap reconstruction often need blood transfusions due to massive blood loss. With the increasing limitations of allogeneic blood transfusion (ABT), doctors are considering acute normovolemic hemodilution (ANH) because of its advantages. By comparing the differences in the (Δ) blood indices and postoperative complications of patients receiving ABT or ANH during the reconstruction and repair of oral and maxillofacial tumor flaps, this study's purpose was to provide a reference for the clinical application of ANH. METHODS The clinical data of 276 patients who underwent oral and maxillofacial flap reconstruction from September 25, 2017, to October 11, 2021, in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, were retrospectively analyzed. According to the intraoperative blood transfusion mode, the patients were divided into two groups: ABT and ANH. The differences in the (Δ) blood indices and the incidence of postoperative complications between the groups were analyzed. RESULTS Among the 276 patients who had ANH (124/276) and ABT (152/276), there were no differences in (Δ) Hb, (Δ) PT, or (Δ) FIB (P > 0.05), while (Δ) WBC, (Δ) PLT, (Δ) APTT and (Δ) D-dimer were significantly different (P < 0.05). The blood transfusion method was not an independent factor for flap crisis (P > 0.05). The wound infection probability in patients with high post-PTs was 1.953 times greater than that in patients with low post-PTs (OR = 1.953, 95% CI: 1.232 ∼ 3.095, P = 0.004). A normal or overweight BMI was a protective factor for pulmonary infection, and the incidence of pulmonary infection in these patients was only 0.089 times that of patients with a low BMI (OR = 0.089, 95% CI: 0.017 ∼ 0.462). Moreover, a high ASA grade promoted the occurrence of pulmonary infection (OR = 6.373, 95% CI: 1.681 ∼ 24.163). The blood transfusion mode (B = 0.310, β = 0.360, P < 0.001; ANH: ln hospital stay = 2.20 ± 0.37; ABT: ln hospital stay = 2.54 ± 0.42) improved the length of hospital stay. CONCLUSION Preoperative and postoperative blood transfusion (Δ) Hb, (Δ) PT, and (Δ) FIB did not differ; (Δ) WBC, (Δ) PLT, (Δ) APTT, and (Δ) D-dimer did differ. There was no difference in the effects of the two blood transfusion methods on flap crisis, incision infection or lung infection after flap reconstruction, but ANH resulted in a 3.65 day shorter average hospital stay than did ABT.
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Affiliation(s)
- Wenhao Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Xueer Li
- Department of Maxillofacial Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, 19th Nonglinxia Road, Guangzhou, Guangdong, 510080, China
| | - Yanhong Chen
- Department of Transfusion Medicine, Sun Yat-sen Memorial Hospital, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Yanling Li
- Department of Transfusion Medicine, Sun Yat-sen Memorial Hospital, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Rui Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Ziqin Kang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
| | - Yili Zhao
- Department of Transfusion Medicine, Sun Yat-sen Memorial Hospital, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
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2
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Perini FV, Montano-Pedroso JC, Oliveira LC, Donizetti E, Rodrigues RDR, Rizzo SRCP, Rabello G, Junior DML. Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Acute normovolemic hemodilution and intraoperative autotransfusion. Hematol Transfus Cell Ther 2024; 46 Suppl 1:S48-S52. [PMID: 38580495 PMCID: PMC11069068 DOI: 10.1016/j.htct.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 04/07/2024] Open
Abstract
Autologous blood transfusion can be achieved through different techniques, including by the patient donating blood before surgery (pre-deposit), collecting blood from the patient immediately before the operation and replacing the volume with colloids or plasma expanders (acute normovolemic hemodilution) or through the salvage of lost blood, during or immediately after surgery, and its retransfusion after washing (intraoperative or postoperative recovery). We will focus on the two methods used intraoperatively that are of fundamental importance in the management and conservation of the patient's own blood.
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Affiliation(s)
- Fernanda Vieira Perini
- Grupo GSH - Gestor de Serviços de Hemoterapia, São Paulo, SP, Brazil; Associação Beneficente Síria HCOR, São Paulo, SP, Brazil
| | - Juan Carlos Montano-Pedroso
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil; Instituto de Assistência Médica do Servidor Público Estadual (Iamspe), São Paulo, SP, Brazil
| | - Luciana Correa Oliveira
- Hemocentro de Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Roseny Dos Reis Rodrigues
- Hospital Israelita Albert Einstein são Paulo, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | | | - Guilherme Rabello
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor - HCFMUSP), São Paulo, SP, Brazil.
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Shi Y, Zhu B, Zhang Y, Huang Y. Anesthetic management of a huge retroperitoneal leiomyoma: a case report. Perioper Med (Lond) 2023; 12:64. [PMID: 38017529 PMCID: PMC10683212 DOI: 10.1186/s13741-023-00352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Retroperitoneal leiomyomas are rare, with just over 100 cases reported in the literature. Perioperative management of retroperitoneal leiomyomas can be challenging due to the large tumor size and the risk of hemorrhage. CASE PRESENTATION We report a case of a 40-year-old Han woman with a 40-cm retroperitoneal leiomyoma. General anesthesia was performed for the surgical resection. Key flow parameters like cardiac output and stroke volume variation, as shown by the Vigileo™-FloTrac™ system, enabled the anesthesiologist to implement goal-directed fluid optimization. Acute normovolemic hemodilution and cell salvage technique were used resulting in a successful en bloc tumor resection with a 6000-mL estimated blood loss. Although the patient experienced postoperative bowel obstruction, no other significant complications were observed. CONCLUSION Advanced hemodynamic monitoring and modern patient blood management strategies are particularly helpful for anesthetic management of huge retroperitoneal leiomyomas.
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Affiliation(s)
- Yue Shi
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Bo Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yu Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
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4
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Schupper AJ, Kaufman M, Reidler JS, Arginteanu MS, Moore FM, Steinberger A, Syed ON, Yao KC, Gologorsky Y. Spinal deformity surgery in patients for whom blood transfusion is not an option: a single-center experience. J Neurosurg Spine 2023; 38:348-356. [PMID: 36866794 DOI: 10.3171/2022.11.spine221061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Spinal deformity surgery is associated with significant blood loss, often requiring the transfusion of blood and/or blood products. For patients declining blood or blood products, even in the face of life-threatening blood loss, spinal deformity surgery has been associated with high rates of morbidity and mortality. For these reasons, patients for whom blood transfusion is not an option have historically been denied spinal deformity surgery. METHODS The authors retrospectively reviewed a prospectively collected data set. All patients declining blood transfusion who underwent spinal deformity surgery at a single institution between January 2002 and September 2021 were identified. Demographics collected included age, sex, diagnosis, details of any prior surgery, and medical comorbidities. Perioperative variables included levels decompressed and instrumented, estimated blood loss, blood conservation techniques used, length of surgery, length of hospital stay, and complications from surgery. Radiographic measurements included, where appropriate, sagittal vertical axis correction, Cobb angle correction, and regional angular correction. RESULTS Spinal deformity surgery was performed in 31 patients (18 male, 13 female) over 37 admissions. The median age at surgery was 41.2 years (range 10.9-70.1 years), and 64.5% had significant medical comorbidities. A median of 9 levels (range 5-16 levels) were instrumented per surgery, and the median estimated blood loss was 800 mL (range 200-3000 mL). Posterior column osteotomies were performed in all surgeries, and pedicle subtraction osteotomies in 6 cases. Multiple blood conservation techniques were used in all patients. Preoperative erythropoietin was administered prior to 23 surgeries, intraoperative cell salvage was used in all, acute normovolemic hemodilution was performed in 20, and perioperative administration of antifibrinolytic agents was performed in 28 surgeries. No allogenic blood transfusions were administered. Surgery was staged intentionally in 5 cases, and there was 1 unintended staging due to intraoperative blood loss from a vascular injury. There was 1 readmission for a pulmonary embolus. There were 2 minor postoperative complications. The median length of stay was 6 days (range 3-28 days). Deformity correction and the goals of surgery were achieved in all patients. Two patients underwent revision surgery during the follow-up period: one for pseudarthrosis and the other for proximal junctional kyphosis. CONCLUSIONS With proper preoperative planning and judicious use of blood conservation techniques, spinal deformity surgery may be performed safely in patients for whom blood transfusion is not an option. The same techniques can be applied widely to the general population in order to minimize blood loss and the need for allogeneic blood transfusion.
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Affiliation(s)
| | - Margit Kaufman
- and Departments of2Anesthesiology and Critical Care Medicine
| | - Jay S Reidler
- 3Orthopaedic Surgery, Mount Sinai Health System, New York, New York
- 4Orthopaedic Surgery, and
| | - Marc S Arginteanu
- Departments of1Neurosurgery and
- 5Neurosurgery, Englewood Health, Englewood, New Jersey
| | - Frank M Moore
- Departments of1Neurosurgery and
- 5Neurosurgery, Englewood Health, Englewood, New Jersey
| | - Alfred Steinberger
- Departments of1Neurosurgery and
- 5Neurosurgery, Englewood Health, Englewood, New Jersey
| | - Omar N Syed
- Departments of1Neurosurgery and
- 5Neurosurgery, Englewood Health, Englewood, New Jersey
| | - Kevin C Yao
- Departments of1Neurosurgery and
- 5Neurosurgery, Englewood Health, Englewood, New Jersey
| | - Yakov Gologorsky
- Departments of1Neurosurgery and
- 5Neurosurgery, Englewood Health, Englewood, New Jersey
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Sharma R, Huang Y, Dizdarevic A. Blood Conservation Techniques and Strategies in Orthopedic Anesthesia Practice. Anesthesiol Clin 2022; 40:511-527. [PMID: 36049878 DOI: 10.1016/j.anclin.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Orthopedic surgery procedures involving joint arthroplasty, complex spine, long bone and pelvis procedure, and trauma and oncological cases can be associated with a high risk of bleeding and need for blood transfusion, making efforts to optimize patient care and reduce blood loss very important. Patient blood management programs incorporate efforts to optimize preoperative anemia, develop transfusion protocols and restrictive hemoglobin triggers, advance surgical and anesthesia practice, and use antifibrinolytic therapies. Perioperative management of anticoagulant therapies, a multidisciplinary decision-making task, weighs in risks and benefits of thromboembolic risk and surgical bleeding and is patient- and surgery-specific.
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Affiliation(s)
- Richa Sharma
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA. https://twitter.com/Drsharma_richa
| | - Yolanda Huang
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA
| | - Anis Dizdarevic
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA.
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Tripković B, Jakovina Blažeković S, Bratić V, Tripković M. CONTEMPORARY RECOMMENDATIONS ON PATIENT BLOOD MANAGEMENT IN JOINT ARTHROPLASTY. Acta Clin Croat 2022; 61:78-83. [PMID: 36824646 PMCID: PMC9942475 DOI: 10.20471/acc.2022.61.s2.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Hip and knee replacement surgery are a common and effective procedure for the relief of pain and loss of function. The number of procedures is increasing and great interest is given how to improve outcome following hip and knee replacement surgery. Last two decades have been characterized by many innovations in hip and knee replacement surgery including minimally invasive technique but also by improvements in anesthetic technique and blood management. The patients undergoing hip and knee replacement surgery are commonly elderly and have cos-existing organ dysfunctions. These procedures are characterized by great perioperative disturbances including cardiovascular complications, high incidence of thromboembolic complications, possible significant perioperative blood loss, possible bone cement effect and high level of postoperative pain. Anesthetic assessment of patients include preoperative preparations, intraoperative and postoperative care. In this article, all problems of perioperative blood management are discussed. The recent data of advantages of blood management for every patient are outlined. Blood management include preoperative preparation, use of autologous blood in perioperative period and administration of drugs for minimizing intraoperative blood loss. The final result of improvements in blood management is reducing in blood loss and need for allogeneic blood and significant reduction in perioperative morbidity.
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Affiliation(s)
- Branko Tripković
- Department of Anesthesiology, Reanimatology and Intensive care, University Hospital Zagreb, University of Zagreb School of Medicine.
| | - Sanja Jakovina Blažeković
- Department of Anesthesiology, Reanimatology and Intensive care, University Hospital Zagreb, University of Zagreb School of Medicine.
| | - Vesna Bratić
- Department of Anesthesiology, Reanimatology and Intensive care, University Hospital Zagreb, University of Zagreb School of Medicine.
| | - Marko Tripković
- Department of Anesthesiology, Reanimatology and Intensive care, University Hospital Zagreb, University of Zagreb School of Medicine.
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Li Y, Zhang Y, Fang X. Acute normovolemic hemodilution in combination with tranexamic acid is an effective strategy for blood management in lumbar spinal fusion surgery. J Orthop Surg Res 2022; 17:71. [PMID: 35123513 PMCID: PMC8817589 DOI: 10.1186/s13018-022-02950-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background The retrospective study was designed to compare the effectiveness and safety of acute normovolemic hemodilution (ANH), tranexamic Acid (TXA), and a combination of ANH and TXA in lumbar spinal fusion surgery. Methods Data of 120 patients underwent multi-level posterior spinal fusion for treating degenerative lumbar disease between June 2013 and December 2017 was collected, retrospectively. Four treatment strategies were enrolled, including ANH, TXA, a combination of ANH and TXA, and without any patient blood management. Intraoperative blood loss, hemoglobin and PCV at the end of surgery and at the postoperative first day, and postoperative drain collection, and intraoperative and postoperative transfusion and rate of transfusion were also collected. Results Intraoperative blood loss and postoperative drain collection of the TXA group, ANH combined with TXA group were statistically lower than those in the control group and ANH group (P < 0.05). Intraoperative and postoperative transfusion amount and rate of intra-operative allogenic transfusion of the ANH group, TXA group, and ANH combined with TXA group were statistically lower than those of the control group (P < 0.05). Hemoglobin and PCV at postoperative the first day in the ANH group, TXA group, and ANH combined with TXA group were significant higher than those in the control group (P < 0.05). The combination of TXA and ANH group achieved the lowest intraoperative blood loss, postoperative drain collection and allogenic transfusion rate. Conclusion A combination of TXA and ANH might be an effective strategy for reducing the rate of transfusion and blood loss in patients underwent lumbar spinal fusion surgery.
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Ng VY, Hollander KN, Carr SR, Tanaka K. Total Intravenous Anesthesia and Acute Normovolemic Hemodilution for Sarcoma Surgery. Cureus 2020; 12:e11319. [PMID: 33282594 PMCID: PMC7717086 DOI: 10.7759/cureus.11319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite optimal local control for high-risk soft tissue sarcomas (STS) with radiation and surgery, there are no other interventions that clearly and significantly reduce the risk of distant relapse after resection. Cytotoxic chemotherapy for localized STS is controversial and is associated with significant side effects. There are significant biologic perturbations that occur at the time of operation and numerous studies have demonstrated that surgical removal of the primary tumor can accelerate the growth of subclinical metastases. While the exact etiology of this phenomenon is unknown, there is some evidence to suggest that allogeneic blood transfusion and volatile inhaled anesthetics may be associated with tumor-promoting processes. At our institution, we have utilized acute normovolemic hemodilution and total intravenous propofol-based anesthesia to avoid these potentially detrimental factors.
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Affiliation(s)
- Vincent Y Ng
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, USA.,Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, USA
| | - Kimberly N Hollander
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, USA
| | - Shamus R Carr
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Kenichi Tanaka
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, USA
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