ABSTRACT
New agents such as recombinant human erythropoietin (rHu EPO) modify conventional transfusionnal strategies. For accurate indications, such as, anaemia associated with chronic renal failure, cancer or cardiac disease, the preoperative prescription of rHu EPO may reduce transfusion requirements. rHu EPO may also be associated with pre-deposit transfusion in patients with anaemia before blood donation, when the transfusion needs are high, or the period for blood pre-deposit donation shortened. Postoperatively rHu EPO is only efficient if it is administered for a prolonged period; this condition limits its indications and value because of its high cost.
Subject(s)
Blood Transfusion/methods , Elective Surgical Procedures , Erythropoietin/therapeutic use , Aprotinin/administration & dosage , Blood Transfusion/economics , Hemostatics/administration & dosage , Humans , Plasma Substitutes/administration & dosage , Practice Guidelines as Topic , Preoperative Care/methods , Recombinant ProteinsABSTRACT
Carotid endarterectomy with clamping is performed in 50 patients. Internal carotid artery stump pressure is measured in all cases after clamping at the beginning of the operation. In 35 patients, an increase of systolic pressure is observed which allows a stump pressure more than 70 mmHg in 29 patients. In 15 patients, systolic pressure decreases and a stump pressure more than 70 mmHg is observed in two patients. When the stump pressure is more than 70 mmHg, the clamping is maintained. When the stump pressure is low, the clamping is stopped. A perfusion of Metaraminol increases systolic pressure in all cases: stump pressure is measured again after a second clamping. In 17 cases out of 19, stump pressure increases more than 70 mmHg and the clamping is maintained. In the two cases with a low stump pressure, a shunt is used during intervention.
