Recovery of intraoperatively shed blood in aortoiliac surgery: comparison of cell washing with simple filtration.

To regain blood shed intraoperatively, two different systems are clinically established: washing and centrifuging red blood cells to produce autologous erythrocyte concentrates and devices for immediate reinfusion of whole blood after mere filtration. In a prospective-randomised study to compare both methods regarding their efficiency, adverse effects, and economy, 20 patients of our department undergoing elective aortoiliac surgery received intraoperative autotransfusion by means of either cell-washing (CS) or salvage of whole blood (WB). Patients were preoperatively randomized into one of the two groups and were evaluated with respect to standard metabolic and haematological laboratory parameters preoperatively, during surgery, after transfer into the recovery room, 24 h after surgery, after transfer into the recovery room, 24 h after surgery, and at discharge. Both patient groups were well comparable in demographics, preoperative laboratory data, and indication for operation. Handling was easier, the set-up time was shorter with the whole blood filtration device (10.2 +/- 2.3 versus 21 +/- 1.9 min, p = 0.0023), and no additional personnel was needed to run the system. The whole blood device also allowed a greater percentage of aspirated blood to be returned intraoperatively compared to cell washing (73.5% +/- 7.2 versus 51.1% +/- 6.5, p = 0.03). Thrombocytopenia occurred in 7 (CS) and 3 (WB) patients intraoperatively with a significant difference in platelet count between the two groups (118 +/- 17 [CS] versus 170 +/- 12 [WB]*10(9)/L, p = 0.025). Expected changes in the perioperative course of the clotting parameters such as highly increased PTT levels and moderately prolonged prothrombin times occurred in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Regional anesthetic procedures in pediatric anesthesia]. / Regionalanästhesiologische Verfahren im Konzept der Kinderanästhesie.

Regional anaesthetic procedures are not popular in paediatric anaesthesia in many institutions. However, regional anaesthesia is gaining ground, especially in a "new" concept of balanced paediatric anaesthesia. The decisive argument for the use of regional anaesthesia is the prolongation of pain relief further into the postoperative phase. The minimal haemodynamic and respiratory side effects during epidural and spinal anaesthesia, the reduced narcotic requirement and the potential early mobilisation all speak in favour of practical application of these techniques. Specially adapted needles and catheters have reduced the technical limitations. The use of nerve stimulators has optimize the accuracy of needle and catheter positioning. The use of a nerve stimulator is therefore highly recommended for peripheral nerve blocks in children. On the other hand, the use of regional anaesthesia in children has potential disadvantages, which should be considered. Special knowledge and continuous training are required. Many techniques are time consuming and personnel intensive, at least temporarily, and the combination of general and regional anesthesia exposes the child to the potential risk inherent in both procedures. The aim of this paper is to discuss procedures which have gained favour in paediatric regional anaesthesia during the past few years. These include caudal, epidural and spinal anaesthesia, especially for infants with high narcotic risk, as well as fascia iliaca compartment blocks for lower extremity analgesia and penile blocks. Many peripheral nerve blocks require special experience and therefore are not discussed here, but they are used routinely by specialists in all age groups. Good anatomic and pharmacologic knowledge should be a prerequisite for all physicians who use regional anaesthetic procedures. Continuous training and critical analysis are needed for good results. Only then can such methods be introduced into routine paediatric anaesthetic practice.