Erythropoietin therapy and preoperative autologous blood donation in children undergoing open heart surgery.

We assessed the feasibility and efficacy of subcutaneous erythropoietin alpha (EPO) therapy and preoperative autologous blood donation (ABD) in children undergoing open heart surgery. Thirty-nine children were treated consecutively with EPO (100 U x kg(-1) s.c. three times a week in the 3 weeks preceding the operation and i.v. on the day of surgery) and two ABDs were made (Group 1). As controls to compare transfusion requirements, 39 consecutive age-matched patients who had undergone open heart surgery during the two preceding years were selected (Group 2). In a mean time of 20 (SD 5) days, 96% of scheduled ABDs were performed and only three mild vasovagal reactions were observed. The mean volume of autologous red blood cells (RBC) collected was 6 (1) ml x kg(-1) and the mean volume of autologous RBC produced as a result of EPO therapy before surgery was 7 (3) ml x kg(-1), corresponding to a 28 (11)% increase in circulating RBC volume. The mean volume of autologous RBC collected was not different from that produced [6 (1) vs 7 (3) ml x kg(-1), P=0.4]. Allogenic blood was administered to three out of 39 children in Group 1 (7.7%) and to 24 out of 39 (61.5%) in Group 2. Treatment with subcutaneous EPO increases the amount of autologous blood that can be collected and minimizes allogenic blood exposure in children undergoing open heart surgery.

[Evaluation of a protocol of health surveillance for the personnel exposed to inhalation anesthetics in a sample of 3 operating rooms]. / Valutazione di un protocollo di sorveglianza sanitaria per il personale esposto ad anestetici inalatori in tre sale operatorie campione.

OBJECTIVES: To verify the results of a health surveillance protocol for personnel exposed to inhalation anaesthetics. DESIGN: Yearly follow-up of operating room personnel. SETTING: Operating theatres of a university hospital; one "clean" room with waste anaesthetic scavengers, a second older room an thus "dirty", a third room with appropriate technical requirements, but with a considerable environmental emission of anaesthetics. PATIENTS OR PARTICIPANTS: Twenty-four technical surgical assistants and anaesthesiologists. INTERVENTION OR METHODS: Determination of the number of changes of air by means of concentration decay; determination of the baseline and final value of the environmental anaesthetics by infrared photoacoustic spectroscopy; analysis of the microclimate and inspection of the equipment. Determination of anaesthetics in the urine of personnel at the end of the work shift, using a gas-chromatograph with head space. Yearly medical check-up and blood tests. RESULTS: In the first year of observation we found values of nitrous oxide in one room and of isoflurane in all three rooms which exceeded the upper limit value. Acceptable values in all the rooms were detected during the second year. The values of anaesthetics found in urine samples reflected those measured in the rooms. Personnel reported subjective symptoms, but no blood alterations related to exposure were found. CONCLUSIONS: The application of the protocol has allow us to estimate the level of pollution and to suggest behavioral rules and technical precautions that have decreased the emission of anaesthetics in the environment. Blood tests are not a valid index of possible damage caused by exposure.

[Intravenous versus inhalation anesthetics in anesthesia for bone marrow harvest for transplantation]. / Anestetici endovenosi versus inalatori nell'anestesia per il prelievo di midollo osseo a scopo di trapianto.

It is well known that nitrous oxide and many volatile anaesthetic drugs possess a certain degree of myelodepressive activity. The authors' aim has been to evaluate the degree of proliferative activity after exposure to forane or propofol. Bone marrow samples have been cultured after general anaesthesia induced and maintained by the same agents; cultures have also been performed after samples exposure to forane and propofol. The results have not shown significative differences in the haemopoietic colonies growth of bone marrow harvested from patients underwent intravenous or inhalatory anaesthesia. In vitro study has shown a significative variation of the colonies growth at the forane higher concentration. Intravenous anaesthetic may be safer for bone marrow harvest for transplantation.

Behaviour of urinary D-glucaric acid excretion in surgical patients and anaesthesiology staff acutely exposed to isoflurane and nitrous oxide.

Liver function abnormalities have been observed in humans exposed to anaesthetics inhalation. Furthermore, experimental studies have revealed changes in microsomal enzyme activity caused by inhalation of a variety of anaesthetics. The study was designed to assess liver microsomal enzyme function by means of a simple non-invasive test, i.e., measurement of urinary D-glucaric acid (UDGA) excretion. Three groups of selected subjects were examined: (i) 20 patients undergoing orthopaedic surgery receiving an anesthetic mixture, (ii) 18 workers of an Anesthesiology and Intensive Care Unit, occupationally exposed to anesthetics, (iii) 16 controls. Both in the patients and anesthesiology staff, the post-operative UDGA mean values were significantly increased compared to the pre-operative values. The study shows that the behaviour of UDGA excretion is similar in patients and in anaesthesiology staff. Although it is not possible to clarify the mechanism involved, this finding is regarded as a response of the liver to anaesthetics administration in patients and to both environmental pollution and occupational stress in hospital staff.

[D-glucaric acid. A new method proposed to investigate damage from exposure to anesthetic gas and vapors]. / Acido D-Glucarico. Una nuova metodologia proposta per indagare il danno da esposizione a gas e vapori anestetici.

Acute exposure and hepatotoxicity following full anesthetic doses is controversial, despite various experimental trials. On the other hand, microsomial enzyme induction following the chronic use of anesthetic gases and vapours, even with minimal metabolism, has been established. Therefore, there is increasing interest in the field of prevention to develop techniques and instruments to minimize pollution of anesthetic vapours and screening methods to detect early liver-damage. We have evaluated the reliability of D-Glucaric Acid test in monitoring microsomial enzyme induction after anesthesia. We evaluated urinary excretion of D-Glucaric Acid before and after exposure to anesthetic gases in 53 subjects, including medical personnel and patients. Statistical analysis of these data confirm the usefulness of this technique to assess acute liver damage in patients undergoing general anesthesia (postoperative increase of 10.5 microns/l as average value of urinary acid excretion, chi 2 = 9.8; p less than 0.01). This technique is also valuable in demonstrating damage in operating room personnel due to chronic exposure (base values greater than 12 microns/l in anesthesiologists with a 9 microns/l increase at the end of surgical intervention, chi 2 = 8.1; p less than 0.01). Data of patients submitted to local anesthesia are more difficult to interprete. They presented a decrease in acid urinary excretion (less than 10 microns/l; chi 2 = 1.93; p less than 0.2) probably due to hemodynamic changes which occurred during spinal block or due to degree of sedation related to de-afferentation itself.

Blood transfusion during cesarean section. A 12 years' retrospective analysis.

Transfusional practice over the last 12 years was investigated retrospectively in 1618 women submitted to lower-segment cesarean section. The overall percentage of transfused patients was low (2.4%) and it has become lower in the last four years (1.1%), in concomitance with the development of better knowledge of tissue oxygenation and with the fear of transmitting infectious diseases, factors which have led anesthesiologists to employ blood only when strictly required. Three conditions greatly increased the risk of bleeding: placenta previa, abruptio placentae and coagulation disorders. Previous cesarean section, fetal distress, dystocias and hypertensive disorders of pregnancy did not increase the risk of bleeding and no difference was found between elective and non-elective surgery. Since for elective surgery two units of blood were crossmatched, the crossmatched/transfused ratio (C/T ratio) was very high (60.8/1). To improve blood bank service efficiency, for surgical operations like cesarean section which rarely require blood, it is possible simply to recur to a type and screen (TS) procedure instead of crossmatching blood, but for categories of patients identified as being at high risk of bleeding--placenta previa, abruptio placentae, coagulation disorders--it is advisable to have crossmatched blood available in the operating theatre.