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To investigate the changes of anesthetic drug concentration in plasma during isolation of autologous blood with acute normovolemic hemodiluti-on and its influence on the depth of anesthesia, muscle relaxant effect and blood drug concentration after reinfusion. METHODS: Forty patients of both sexes, aged 20-60 yr, American Society of Anesthesiologists physical status or Ⅱ, hemoglobin (Hb) >120 g / L, hematocrit (Hct) >35%, undergoing eletive multilevel spinal surgery were included, were divided into 2 groups (n=20 each) using a random number table. ANH group (group A): ANH was performed after stable induction of anesthesia, the target Hct value was 28%-30%, and autologous blood was reinfused after the main operation steps. Control group (group C): routine transfusion and infusion treatment. The bispectral index (BIS) and Train-of-Four stimulation (TOF) were observed and recorded at the stable induction of anesthesia (T1), 30 minutes of stable induction (T2), the end of operation (T3), 30 minutes after the end of the operation (T4), 1 hour after the end of the operation (T5) and 2 hours after the end of the operation (T6). The concentrations of propofol and cisatracurium besylate in plasma at T1-T6, stored blood at 1 h (TS1), 2 h (TS2), and before reinfusion (TS3) were detected by Liquid Chromatography-tandem Mass Spectrometry. The extubation time and recovery score at T4-6 hours were recorded. RESULTS: There was no significant difference in propofol between the two groups at each time point (P > 0.05). The plasma concentration of cisatracurium besylate in group A was higher than that in group C at T3 (P0.05). The BIS value at T4 and TOF value at T3 in group A were significantly lower than those in group C. The recovery score of group A was lower than that of group C at T4 (P0.05). CONCLUSION: The plasma concentrations of propofol and cisatracurium besylate were basically unchanged during the in vitro isolation of ANH autologous blood. The plasma concentrations of cisatracurium besylate were only temporarily affected after the main operation steps, but the postoperative muscle relaxation recovery and recovery quality were not significantly affected.
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【Objective】 To explore the effects of acute normovolemic hemodilution (ANH) combined with intraoperative recycled autotransfusion on blood transfusion volume and coagulation function in elderly patients undergoing cardiac surgery. 【Methods】 A total of 94 elderly patients undergoing cardiac surgery in the hospital were enrolled and randomly divided into observation group (n=47) and control group (n=47) between March 2020 and March 2022. The observation group was given ANH combined with intraoperative recycled autotransfusion, while control group was given routine allogeneic transfusion. The blood transfusion volume, oxygenation status, immune function, inflammatory indexes and adverse reactions in the two groups were compared. 【Results】 The banked blood transfusion volume was less in observation group than control group [(1.73±0.43) U vs (5.71±1.71) U, P<0.05]. At 6 h after surgery, blood oxygen saturation (SvO2) level was higher [(74.59±7.20) % vs (67.22±6.19) %], while oxygen uptake rate (ERO2) level was lower[(0.29±0.06) % vs (0.34±0.05) %] in observation group than control group (P<0.05). At day 1 after surgery, levels of CD3+, CD4+, CD4+ /CD8+ and natural killer cells (NK) were higher [(65.11±5.14) %, (46.93±5.17) %, (1.86±0.30), (8.35±1.23) % vs (57.45±7.24) %, (43.58±4.85) %, (1.47±0.36)%, (7.34±1.38) %], while CD8+ was lower [(25.17±4.01) % vs (30.39±5.06) %] in observation group than control group (P<0.05). At day 1 after surgery, levels of serum interleukin 6/8 (IL-6/8) and tumor necrosis factor-α (TNF-α) were lower in observation group than control group [(104.51±12.55) ng/L vs (125.81±14.96) ng/L, (351.42±52.86) ng/L vs (394.27±55.78) ng/L, (254.93±49.94) ng/L vs (323.60±52.63) ng/L, P<0.05]. The incidence of adverse reactions was lower in observation group than control group (4.26% vs 17.02%), P<0.05. 【Conclusion】 Recycled autotransfusion can reduce allogeneic transfusion volume in elderly patients undergoing cardiac surgery. There is no difference in the effects on blood routine or coagulation function between recycled autotransfusion and allogeneic transfusion. Compared with allogeneic transfusion, recycled autotransfusion can significantly improve oxygenation status, relieve immunosuppression and inflammation response, and reduce the risk of adverse reactions.
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AIM: To observe the effect of acute normovolemic hemodilution (ANH) autologous blood transfusion on the EEG bispectral index and muscle relaxation in elderly patients undergoing orthopedic surgery to explore the influence of autologous blood transfusion containing anesthetic components on the quality and safety of postoperative anesthesia recovery. METHODS: Forty patients, aged 65-75, weighing 55-80 kg, ASA grade I-II, with an estimated intraoperative blood loss of more than 600 mL, were selected for elective orthopedic surgery. The patients were randomly divided into two groups (n=20): group A was given acute normovolemic hemodilution (ANH), and the target value of Hct was 28%-30% after induction of anesthesia; group B was the control group which was given routine fluid infusion during operation without ANH. Bispectral index (BIS), TOF values and plasma concentrations of propofol and cisatracurium were measured at the beginning of autotransfusion (T
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Background: Cardiovascular disease is one of the most common causes of mortality in developed countries, as well as in the whole world. In this regard, autologous transfusion is a topic that can be useful and valuable, especially in complex surgery such as heart surgery and organ transplantation. One of its variants is Acute Normovolomic Hemodilution (ANH). Therefore, the aim of this study was to compare the effect of ANH on the amount of bleeding in the first 48hours after coronary artery bypass grafting.Methods: In this clinical trial, 100 patients were selected from all heart patients referred to Imam Khomeini Hospital in Ardebil for CABG surgery in the years 2016-17. They were selected by simple random sampling as a statistical sample and They were divided into intervention (50 ANH recipients’ people) and control groups (50 without ANH people).Results: Based on the findings, in the ANH recipients’ group, the mean of bleeding volume was 59.1±7.3ml in the first day and 55.6±4.2ml in the control group and the difference between the two groups was not significant on the first day. The mean of bleeding volume on the second day was 46.1±2.8ml in the ANH group and 42.7±2.9ml in the control group. Although it was somewhat higher, it was not statistically significant. Of all samples 45% were female and 55% were male. The most common type of blood group was 33 (33%) in the blood group O. The highest age group (61%) was over the 60 years old. The pump time varied with an average of 122.2±21.5minutes. The lowest value was PT 11 and the highest was 15 with an average of 13.02±0.9seconds. The mean of PTT was 32.5±2.6seconds and the mean INR was 1.1±1.0. The average plt was 251170±64124. The mean ACT was 596 / 6±183/7seconds.Conclusions: The results showed that in the mean of bleeding volume between the intervention and control groups (p = 0.41), bleeding volume by age (p = 0.3), bleeding volume by gender (p =0.54) and bleeding volume by blood group (p=0.48) was not significant difference. Based on these results, it is suggested that more studies be done on the more number of samples.
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Objective To observe the effects of acute normovolemic hemodilution(ANH) plus tranexamic acid on blood loss and blood transfusion in patients with total knee replacement.Methods 98 cases of patients with total knee replacement were divided into ANH group and combination group by computer randomization,49 cases in each group.ANH was performed in ANH group,and ANH plus tranexamic acid was given in combination group.The changes of hemoglobin(Hb),red blood cells deposited(Hct),platelet count(PLT) were observed before and after autologous blood transfusion in two group.The changes of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),D-dimer were observed at preoperative and postoperative in two group.The amount of blood loss and allogeneic blood infusion,the urine volume and the postoperative flow volume were recorded in two groups.Results The average levels of Hb,Hct after autologous blood transfusion in combination group were higher than those in ANH group,the differences were statistically significant(P<0.05).The average level of D-dimer at postoperative in combination group were higher than that in ANH group,the difference was statistically significant(P<0.05).The amounts of blood loss and allogeneic blood infusion,the postoperative flow volume were lower than those in ANH group,the differences were statistically significant(P<0.05).Conclusion The joint application of ANH and tranexamic acid can effectively reduce the amounts of blood loss and allogeneic blood infusion in patients with total knee replacement,and has a certain clinical value.
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BACKGROUND: The possible impact of hemodilution during acute normovolemic hemodilution (ANH) using hydroxyethyl starch (HES) on intraoperative serum concentration of creatinine (s-Cr) has not been well investigated. METHODS: Patients undergoing cardiac surgery were randomly allocated into Group-ANH (n = 15) or Group-C (control; n = 17). In Group-ANH, 5 ml/kg whole blood was collected, and they were administered 5 ml/kg of HES 130/0.4 after anesthesia induction and before initiating cardiopulmonary bypass (CPB). In both groups, moderate hypothermic CPB was initiated using 1,600–1,800 ml of bloodless priming solution. The changes of s-Cr, blood urea nitrogen, hematocrit (Hct), electrolytes, and osmolality were determined before ANH administration (T1), after administering ANH 5 ml/kg (T2), 30 and 60 s after the initiation of CPB (T3, T4), and at the end of surgery (T5). RESULTS: In Group-ANH, the s-Cr values at T2 (median [IQR25–75%], 0.83 [0.71–1.00] mg/dl) were not significantly different compared to those at T1 (0.84 [0.64–1.00] mg/dl), while those at T3 and T4 (0.68 [0.61–0.80] and 0.76 [0.59–0.92] mg/dl, respectively) were significantly lower than those at T2 (0.83 [0.71–1.00] mg/dl, P < 0.001). Hct at T3, T4 and T5 were significantly lower than those of T1 in both groups, and those at T2 and T4 of Group-ANH were significantly lower than those of Group-C (P < 0.001). There was no significant inter-group difference in all other parameters. CONCLUSIONS: Intraoperative s-Cr was not affected by the administration of ANH 5 ml/kg, although it reduced transiently at the beginning of CPB. Further study is needed to determine the clinical relevancy of our results.
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Humanos , Anestesia , Nitrógeno de la Urea Sanguínea , Puente Cardiopulmonar , Creatinina , Electrólitos , Hematócrito , Hemodilución , Concentración Osmolar , Almidón , Cirugía TorácicaRESUMEN
Objective To investigate the effect of acute normovolemic hemodilution (ANH) combined with controlled hypotension (CH) on the extravascular lung water (EVLW) and oxygenation in elderly orthopaedic surgery patients.Methods Forty-five elderly orthopaedics surgery patients,23 males,22 females,aged 65-75 years old,ASA grade Ⅰ or Ⅱ,were randomly divided into 3 groups (n=15 each).Group A,served as control,received regular routine transfusion and intraoperative crystalloid fluids and colloidal liquid to add volume.Group B,namely ANH group,received normovolemic hemodilution till Hct reaching 30% after induction of anesthesia.Group C,ANH combined with CH group,received ANH with Hct reaching 30% after induction of anesthesia,and the patients were continuously pumped nitroglycerin combined with esmolol for controlled hypotension.The target mean arterial pressure controlled and cut by 30% below the basic value.We collected arterial blood for blood gas analysis at 5 points: before before induction of anesthesia (T1),immediately after ANH (T2),30 min after ANH (T3),30 min after CH (T4),immediately after surgery (T5).Meanwhile the MAP,HR,PaO2,SpO2,Hct,HCO3-,pH,cardiac index (CI),stroke volume variation (SVV),stroke volume index (SVI),extravascular lung water index (EVLWI) and intrathoracic blood volume index (ITBVI) were recorded.Blood loss,urine output after surgery and the operation time were also recorded.Results The volumes of autoblood removed had no significant difference between group B and group C,and no autoblood was removed in group A.The volume of blood loss in group C was significantly less than that in group A and group B (P<0.05).Six cases in group A,one case in group B and none in group C needed homologous allogeneic blood transfusion.Compared with T1,MAP,HR,CI,SVI and Hct were significantly decreased at T2-T5 (P<0.05),but all those are stable in the normal range.Compared with T1,SVV was significantly decreased at T2-T4 (P<0.05).Compared with T1,ITBVI,PaO2 and SpO2 were increased at T2-T5 (P<0.05),but all those are stable in the normal range.CI and SVI at T2 in group A was significantly lower than that in group B and C.Compared with group A and B,MAP at T4 in group C were significantly decreased and SVV at T4 in group C were significantly increased(P<0.05).Urine output,the operation time,EVLWI,HCO3-and pH in three groups had no significant difference.Conclusion Acute normovolemic hemodilution combined with controlled hypotension has an effect of saving blood in elderly patients,without any influence on the extravascular lung water and oxygenation,which can be used safely in elderly patients which they are monitored.
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Objective To observe the effect of acute normovolemic hemodilution(ANH)combined with enhanced recovery after surgery(ERAS)on immune function in patients undergoing hepatic lobectomy. Methods 80 patients were divided into two groups:ERAS group(group E),ANH combined with ERAS group(group AE). bleeding volume,blood transfusion,infused fluid volume,urine output during operation and clinical index after surgery were recorded. Exhaust and defecation time ,fluid intake time and hospitalization duration were also record-ed. Blood samples were obtained from the patients at 30 min before anesthesia induction(T1),immediately(T2), 24 h(T3),3 d(T4)and 7 d(T5)after the end of operation for determination of the expression of CD3+,CD4+, CD8+ on T cells and natural killer cell. Results In group E ,CD3+,CD4+ T-lymphocytes and NK cells at T2-3 decreased as compared with T0. Compared with group E ,no allogeneic blood transfusion cases were found and clinical index duration was shorter in group AE. CD3+,CD4+T-lymphocytes and NK cells at T2-3 increased in group AE as compared with those in Group E. The difference is significant (P < 0.05). Conclusion ANH combined with ERAS can decrease allogenic blood transfusion and increase post-operation immunologic function ,shorten the postoperative hospitalization time.
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Objective To explore the application value of acute normovolemic hemodilution(ANH) combined with salvaged autotransfusion in surgical patients with ectopic pregnancy.Methods From Mar.2015 to Apr.2016,46 surgical patients with ectopic pregnancy,receiving ANH combined with salvaged autotransfusion,were enrolled as observation group,and 39 surgical patients with ectopic pregnancy,receiving allogeneic blood transfusion were enrolled as control group.The baseline data,including age,body mass index(BMI),preoperative hemoglobin(Hb),abdominal pain time and menopause time were collected.The amounts of blood loss and blood transfusion were recorded.Preoperative and postoperative levels of white blood cells(WBC),C-reaction group(CRP) and erythrocyte sedimentation rate(ESR) were detected.Results The baseline data,including age,BMI,preoperative Hb,abdominal pain time and menopause time of the two groups were without statistical difference(P>0.05).The preoperative preexisting blood volume was (559±128)mL and the intraoperative blood collection was(510±103)mL in observation group.The cases and volume of banked blood infusion in observation group were lower than those in control group(P0.05).The levels of CRP and ESR at the postoperative 1st,3rd and 5th day and WBC levels at the postoperative 1st and 3rd day were higher than those before operation in the two groups(P<0.05).The levels of CRP and ESR at the postoperative 1st,3rd and 5th day in observation group were significantly lower than those in control group(P<0.05).Conclusion (Department of Gynaecology,the Fourth People's Hospital of Langfang City,Langfang,Hebei 065700,China)
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Autologous blood transfusion (ABT) has been gradually attracting more attention due to the increasingly prominent problem of blood transfusion safety and blood shortage in recent years. With the rapid development of blood conservation techniques, blood component separation technology, blood transfusion medicine and a constant increase in clinical needs, ABT technology has been expanded and innovated to a large degree. In this study, the development of preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH), intraoperative and postoperative autotransfusion, and other new technologies and theories are reviewed and existing questions are analyzed. Challenges and applications are also discussed in order to provide reference for peers.
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Humanos , Transfusión de Sangre Autóloga , Hemodilución , Atención PerioperativaRESUMEN
Objective To investigate the effects of autologous blood transfusion and acute normovolemic hemodilution inflamma‐tory response in patients with spinal surgery .Methods 60 patients with spinal surgery ,were randomly divided into the control group ,autologous blood transfusion group ,acute normovolemic hemodilution group ,20 cases in each group .The control group in in‐traoperative bleeding time and blood input variants of inventory .Autologous blood transfusion group was used in combination with intraoperative autologous blood recovery unit ,lose banked blood hemoglobin was low .Acute normovolemic hemodilution group via peripheral vein input must first crystal liquid or gel liquid ,then through internal jugular vein slowly pulled out the body′s blood into the special bags containing anticoagulant ,swing machine through blood kept shaking ,input when appropriate .Preoperative(T1) , After surgery 2 h(T2) ,6 h(T3) ,12 h(T4) and 24 h(T5) blood at each time point 5 mL ,detect the WBC ,IL‐6 ,TNF‐α.Records with and without postoperative complications .Results WBC in autologous blood transfusion group and acute normovolemic he‐modilution group were higher than that of preoperative ,difference was statistically significant(P<0 .05);In T2 -T5 ,serum IL‐6 , TNF‐a and the WBC concentration compared with the basis of their respective value(T1) increased significantly ,but were signifi‐cantly lower than control group ,the difference was statistically significant(P< 0 .05) .Postoperative follow‐up of the autologous blood transfusion group and acute normovolemic hemodilution group and no complications .Conclusion The autologous blood trans‐fusion group and acute normovolemic hemodilution group could effectively reduce the intraoperative and postoperative systemic in‐flammatory response ,which obviously save blood resources .
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Introducción: la cirugía cardíaca ocasiona profundas alteraciones fisiopatológicas, con un elevado riesgo de pérdidas sanguíneas y el consecuente peligro para la vida. Objetivo: evaluar el uso de la hemodilución normovolémica aguda en pacientes expuestos a cirugía de revascularización coronaria de forma electiva. Métodos: se efectuó un estudio observacional, descriptivo y transversal de 100 pacientes programados para cirugía electiva de revascularización coronaria, con riesgo quirúrgico II-III, según la clasificación de la ASA, atendidos en el Servicio de Cirugía Cardiovascular del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde septiembre de 2012 hasta marzo de 2014. Resultados: predominaron los hombres entre 55 y 64 años de edad; los parámetros hematológicos, hemodinámicos y hemogasométricos se mantuvieron entre los límites normales durante los períodos presangría, postsangría y posautotransfusión, no se registraron complicaciones durante la realización de la técnica y el ahorro de sangre fue de 97,0 %. Conclusiones: La hemodilución normovolémica aguda limitada es una técnica de ahorro de sangre segura para pacientes a quienes se les realiza cirugía de revascularización coronaria.
Introduction: heart surgery causes deep pathophysiological alterations, with a high risk of blood losses and the consequent danger for life. Objective: to evaluate the use of acute normovolemic hemodilution in patients exposed to coronary artery bypass surgery in an elective way. Methods: an observational, descriptive and cross-sectional study of 100 patients scheduled for elective coronary artery bypass surgery, with surgical risk II-III, according to the classification of the American Society of Anesthesiologists (ASA), assisted in the Cardiovascular Surgery Service of "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, was carried out from September, 2012 to March, 2014. Results: there was a prevalence of men between 55 and 64 years; the hemathologic, hemodynamic and hemogasometric parameters, remained among the normal limits during the before bleeding, after bleeding and postself-transfusion times, there were no complications reports when performing the technique and there was a 97.0% of blood saving. Conclusions: the limited acute normovolemic hemodilution is a safe technique of blood saving for patients undergoing coronary artery bypass surgery.
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Cirugía Torácica , HemodiluciónRESUMEN
Objective To investigate effects of acute normovolemic hemodilution(ANH) used in on-pump coronary artery bypass graft(CABG) surgery.Methods 60 patients had received CABG surgery under cardiopulmonary bypass,of which 30 patients using ANH techniques and 30 patients using no ANH techniques.A series of index were observed and compared between the two groups after operation.Results All patients had been revascularized completely with stable surgical procedure,no serious complications,no operative mortality.Oxygen supplying was balanced with demanding,without tissue hypoxia.Indicators of myocardial protective effect,coagulation,kidney function,degree of systemic inflammatory reaction and postoperative drainage volume were not significantly different between the two groups(P > 0.05).Allogeneic blood transfusion volume of the study group was significantly lower than that of the control group [(1.1 ± 0.8) U vs.(2.3 ± 1.1) U,P < 0.05].Condusion The ANH technique used in CABG operation on appropriate patient is feasible and safe,with satisfactory clinical result.
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Objective To observe the contribution of acute normovolemic hemodilution ( ANH) in experiment of cryopreserved dog limb replantation.Methods Sixteen healthy Beagle dogs (male:female=1:1) were divided into two groups.Dogs in the experiment group ( Group B) received ANH in the limb replantation, and dogs in the control group ( Group A) received the same amount of lactate Ringer’ s solution intravenously during the surgical operation.We recorded and compared the hemodynamic indexes, HB, HCT, the resuscitation time, the first rising head time, the first standing time and the first eating and drinking time between the two groups.Results ( 1 ) During the operation, both PaO2 and PCO2 in the two groups were normal, as well as the breathing rate.The heart rate in the group B was lower than that in the group A.Before blood transfusion, there was no statistically significant difference in HB and HCT between the two groups, but after transfusion they were significantly higher in the group B than in the group A.(2) The resuscitation time, the first rising head time, the first standing time and the first eating and drinking time of the group B were all better than those in the group A.Conclusions In cryopreserved dog limb replantation experiments, acute normovolemic hemodilution is helpful to improve the general condition and facilitate the recovery of animals after limb replantation.
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Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature.
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Humanos , Aorta , Puente Cardiopulmonar , Puente de Arteria Coronaria , Vasos Coronarios , Urgencias Médicas , Eritrocitos , Policitemia Vera , Policitemia , Tromboelastografía , TrombosisRESUMEN
Objective To investigate the efficacy and safety of acute normovolemic hemodilu-tion for pregnant women with total placenta pravia and accreta.Methods Fifty-two pregnant women with placenta praevia and accreta were randomly divided into three groups.Groups A and B received ANH or AHH before the operation while group C received the normal treatment.The total blood loss,transfusion of allogeneic blood and preoperative and postoperative routine blood test were recor-ded;the infants’umblical artery blood samples were taken immediately after birth,and 1 min,5 min Apgar scores and the blood gas was analyzied.Results There were no significant difference in the general condition,operation duration,blood loss among the three groups;the transfusion of allogeneic blood in groups B and C were much more than group A (P <0.05);the postoperative hemoglobin and hematocrit and the count of plateletsin in group A were better than groups B and C (P <0.05),while there were no statistically difference between groups B and C;there were not only seldom difference in the Apgar scores of 1 min and 5 min,but also barely change in the blood gas analysis of umbilical ar-tery in new borns from the three groups.Conclusion ANH could play an important role in the pre-vention of postpartum hemorrhage without doing any harm to the mother and infant.
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The objective of this study was to evaluate the effectiveness of acute normovolemic hemodilution (ANH) as a sole method of reducing allogenic blood requirement in patients undergoing primary elective valve surgery. One hundred eighty eight patients undergoing primary elective valve surgery were prospectively randomized into two groups: Group I (n=100) acted as control and in Group II (n=88) autologous blood was removed (10% of estimated blood volume in patients with hemoglobin (Hb) >12g% and 7% when the Hb was <12g%) in the pre-cardiopulmonary bypass (CPB) period for subsequent re-transfusion after protamine administration. The autologous blood withdrawn was replaced simultaneously with an equal volume of hydroxyl-ethyl starch solution. Banked blood was transfused in both the groups when Hb was ≤6g % on CPB and ≤8g% after CPB. Platelets were transfused when the count fell to <100´10 9 /L and fresh frozen plasma (FFP) was transfused whenever there was diffuse bleeding with laboratory evidence of coagulopathy. The two groups were comparable as regards demographic data, type of surgical procedures performed, duration of CPB and ischemia, duration of elective ventilation and re-exploration for excessive bleeding. The autologous blood withdrawn in patients with Hb≥12g% was 288.3±69.4 mL and 244.4±41.3 mL with Hb<12g% (P=NS). The Hb concentration (g %) was comparable pre-operatively (Group I= 12.1±1.6, Group II= 12.4±1.4), on postoperative day 1 (Group I =10.3±1.1, Group II= 10.6±1.2) and day 7 (Group I = 10.9±1.5, Group II=10.4±1.5). However, the lowest Hb recorded on CPB was significantly lower in Group II (Group I =7.7±1.2, Group II=6.7±0.9, p0 <0.05). There was no difference in the chest tube drainage (Group I =747.2±276.5 mL, Group II=527.6±399.5 mL), blood transfusion (Group I=1.1±1.0 units vs. Group II=1.3±1.0 units intra-operatively and Group I=1.7±1.2 units vs. Group II=1.7±1.4 units post-operatively) and FFP transfusion (Group I =581.4±263.4 mL, Group II=546.5±267.8 mL) in the two groups. We conclude that low volume autologous blood pre-donation does not seem to provide any added advantage as a sole method of reducing allogenic blood requirement in primary elective valve surgery.
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Adulto , Transfusión Sanguínea , Puente Cardiopulmonar , Femenino , Válvulas Cardíacas/cirugía , Hemodilución/métodos , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Procedimientos Quirúrgicos ElectivosRESUMEN
Objective To investigate the effects of acute normovolemic hemodilution(ANH)on intraoperative intracranial pressure(ICP),jugular venous oxygen saturation(SvO_2),and venous blood lactate(VBL)of patients with intracranial tumor, Methods Forty-two patients,elected to perform supratentorial intracranial tumor resection on some certain days,were randomly divided into ANH(n=21)and control (n=21)groups.Bloodletting was performed in the radial artery after anesthesia induction and the same amount of hydroxyethyl starch was injected into the internal jugular vein at the same time so as to induce the haematocrit reaching to 30% in the ANH group.ANH was not performed in the control group.Acetated Ringer's solution was used during the operation in both groups.The level of arterial partial pressure of oxygen(PaO_2),arterial oxygen saturation(SaO_2),venous oxygen partial pressure (PvO_2),mixed venous O_2 saturation(SvO_2)and VBL was measured before hemodilution(T_0),30 min after the hemodilution(T_1),1 h after the hemodilution(T_2),and at the time the operation was finished(T_3)in both groups.And the changes of ICP before hemodilution(T_0),immediate after hemodilution(T_1),30 min after the hemodilution(T_Ⅱ),and before the endocranium was cut open(T_Ⅲ)in both groups. Results The ICP value in the two groups was not significantly different at different time points;The level of SvO_2 in the control group was significantly lower than that in the ANH group at T_2 and T_3(P<0.05);Significantly decreased level of SvO_2 and increased level of VBL was found in the control group at T2 and T_3 as compared with those in the control group at T_0 and T_Ⅱ(P<0.05). Conclusion Maintaining ICP in patients with intracranial tunlor during the operation through performing ANH with Hct reaching 30%,can significantly improve the oxygen supply and consumption in the brain tissue.
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We report two cases of Jehovah's Witness patients who had massive bleeding after surgery. The first case was a 37-year-old woman who underwent an emergency cesarean section; the other was a 48-year-old man with chronic anemia who underwent removal of a large mass. After the operation, their Hb levels were nearly 3.1 g/dl. They were treated with blood conserving methods, divided into 3 periods (pre, post and operative). Both patients completely recovered uneventfully and were discharged on the 19th and 21st postoperative day.
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Adulto , Femenino , Humanos , Persona de Mediana Edad , Anemia , Urgencias Médicas , Eritropoyetina , Hemorragia , Ingenio y Humor como AsuntoRESUMEN
We report two cases of Jehovah's Witness patients who had massive bleeding after surgery. The first case was a 37-year-old woman who underwent an emergency cesarean section; the other was a 48-year-old man with chronic anemia who underwent removal of a large mass. After the operation, their Hb levels were nearly 3.1 g/dl. They were treated with blood conserving methods, divided into 3 periods (pre, post and operative). Both patients completely recovered uneventfully and were discharged on the 19th and 21st postoperative day.