RESUMO
Our hospital is a center for bloodless medicine and surgery (CBMS). It is one of 56 such centers located in the United States. The mission of the center is to provide surgical and medical treatment without the administration of blood or blood-related products. Patients' rights to autonomy and self-determination are respected. Development of the CBMS program required the writing and implementation of specific guidelines, developing standards of care, revising existing policies and procedures, and educating staff members. The CBMS program is multifaceted and multidisciplinary.
Assuntos
Transfusão de Sangue , Cristianismo , Procedimentos Cirúrgicos Minimamente Invasivos , Diretivas Antecipadas , Substitutos Sanguíneos , Transfusão de Sangue/legislação & jurisprudência , Protocolos Clínicos , Connecticut , Eritropoetina/uso terapêutico , Ética , Humanos , Capacitação em Serviço , Procedimentos Cirúrgicos Minimamente Invasivos/enfermagem , Enfermagem Perioperatória/organização & administraçãoRESUMO
We tested in pigs the hypothesis that regional deep hypothermia of the spinal cord achieved by cerebrospinal fluid cooling will protect against ischemic injury during thoracic aortic cross-clamping. Eight control animals underwent aortic cross-clamping at the distal aortic arch and just above the diaphragm for 30 minutes. Eight experimental animals had placement of two subarachnoid perfusion catheters through laminectomies at T4 and the lower lumbar region. The subarachnoid space was perfused with normal saline solution at 6 degrees C delivered by gravity infusion, with infusion rates adjusted to maintain cord temperatures at less than 20 degrees C. After 30 minutes of aortic cross-clamping, the infusion was stopped and the cord allowed to warm to body temperature. Hind limb neurologic function was graded by Tarlov's scale. All of the animals in the control group had complete hind limb paraplegia (Tarlov grade 0) postoperatively. Seven of the 8 animals in the experimental group had preservation of hind limb motor function (Tarlov grade 2), and 1 animal had complete hind limb paraplegia (Tarlov grade 0) (p = 0.002, Fisher's exact test). We conclude that regional deep hypothermia of the spinal cord in pigs does provide some protection from ischemic injury during thoracic aortic cross-clamping. Clinically this may be a useful adjunct for prevention of paraplegia during thoracic aortic operations.
