Haemotherapy for acute haemorrhage

Anesthesia for trauma

Trauma is the leading cause of death for persons aged 1 to 38 years. Successful management is facilitated by prehospital endotracheal intubation, transport to regional trauma centers, rapid resuscitation by an on-site team of trained physicians, timely operative intervention, and provision of care by well-prepared anesthesiologists familiar with the potential complications typical of traumatized patients. No particular anesthetic agent or technique is ideal. Causes for intraoperative hypotension include hypovolemia, hemopneumothorax, pericardial tamponade, an intracranial mass, acidosis, and hypothermia. The anesthesiologist should play an active role in all phases of trauma management, including provision of postoperative intensive care and pain relief.

Improving autologous blood harvest: recovery of red cells from sponges and suction

The efficacy of red cell salvage was assessed under circumstances which simulated blood loss managed with sponges or suction. Expired banked blood was equally divided and processed by either suction, or absorbing the blood on a sponge followed by rinsing the sponge in saline. These two techniques were used to harvest washed, centrifuged erythrocytes. The volume, haematocrit and free haemoglobin concentration of the banked blood and the processed units were measured, and smears from all units were examined microscopically. The red cell mass was calculated as the product of the volume and haematocrit. The red cell mass recovered by suction and from sponges averaged 93% and 87% respectively. Blood lost in sponges can be recovered and used to increase the available autologous blood, thereby reducing the need for donor blood.

Maximum transfusion rates in neonates and infants

A common method of rapid transfusion in neonates and infants is to manually inject an appropriate volume of blood using a syringe connected to a 3-way tap in the infusion tubing. We measured the maximum infusion rates this technique could generate through small bore cannulae (22 ga-25 mm, 24 ga-19 mm), and compared the efficiency of a range of syringe sizes. We also compared infusion rates generated by this technique with those obtained using a pressure pump chamber in the giving set. The manual syringing technique using a 10 ml syringe was the most efficient for all the fluids tested, providing infusion rates through the 22 ga cannulae of 64 ml/min for packed cells, 73 ml/min for whole blood and 105 ml/min for 0.9% saline.

Resuscitation in acute haemorrhage

While some of the details of resuscitation of the bleeding patient remain contentious, the basic principles are clear. Adequate resuscitation implies the prompt restoration of tissue oxygenation by achievement and maintenance of airway patency, adequate ventilation, cardiac rhythm and intravascular volume. The choice of fluid for primary resuscitation is considerably less important than the care with which it ought to be administered. The volume of fluid required for primary resuscitation varies and there is no well-defined endpoint against which to titrate fluid resuscitation. However, as the complications and mortality of shock are related to the degree and the duration of shock, definitive (usually surgical) intervention should be undertaken early if the clinical features of shock cannot be readily reversed or if the maintenance of clinically adequate perfusion cannot be achieved with the administration of less than 200 ml of fluid per hour.