Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient.

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.

Health worker exposure risk during inhalation sedation with sevoflurane using the (AnaConDa ®) anaesthetic conserving device / Riesgo de exposición de los profesionales sanitarios durante sedación inhalatoria con sevoflurane a través del dispositivo anaesthetic conserving device (AnaConDa ®)

Introduction and objective Occupational exposure to sevoflurane should not exceed 2 ppm. During inhalation sedation with sevoflurane using the anaesthetic conserving device (AnaConDa®) in the post-anaesthesia care unit, waste gases can be reduced by gas extraction systems or scavenging devices such as CONTRAfluran™. However, the efficacy of these methods has not been clearly established. To determine the safest scenario for healthcare workers during inhalation sedation with sevoflurane in the post-surgical intensive care unit. Materials and methods: An experimental study on occupational exposure was conducted in a post-cardiothoracic care unit during March-August 2009. The measurements were performed in four post-cardiac surgery sedated adults in post-surgical intensive care unit and four nurses at the bedside, and at four points: scenario A, inhalation sedation without gas extraction system or contrafluran as a reference scenario; scenario B, applying a gas extraction system to the ventilator; scenario C, using contrafluran; and scenario 0, performing intravenous isolation sedation. Sevoflurane concentrations were measured in the nurses’ breathing area during patient care, and at 1.5 and 8 m from the ventilator using diffusive passive monitor badges. Results: All badges corresponding to the nurses’ breathing area were below 2 ppm. Levels of sevoflurane detected using prevention systems were lower than that in the control situation. Only one determination over 2 ppm was found, corresponding to the monitor placed nearest the gas outlet of the ventilator in scenario A. Trace concentrations of sevoflurane were found in scenario 0 during intravenous sedation. Conclusions: Administration of sevoflurane through the AnaConDa® system during inhalation sedation in post-surgical intensive care units is safe for healthcare workers, but gas extraction systems or scavenging systems, such as CONTRAfluran™ should be used to reduce occupational exposure as much as possible (AU)

Introducción y objetivo: La exposición ocupacional al sevoflurano no debe exceder de 2 ppm. Durante la sedación por inhalación con sevoflurano utilizando el dispositivo anestésico conservación ( AnaConDa ®) en la unidad de cuidados post-anestésicos , gases residuales se pueden reducir mediante sistemas de extracción de gases o dispositivos de barrido como CONTRAfluran ™ . Sin embargo , la eficacia de estos métodos no se ha establecido claramente. Para determinar el escenario más seguro para los trabajadores de la salud durante la sedación por inhalación con sevoflurano en la unidad de cuidados intensivos post- quirúrgica. Materiales y métodos: Un estudio experimental sobre la exposición laboral se llevó a cabo en una unidad de cuidados post- cardiotorácica entre marzo y agosto de 2009. Las mediciones se realizaron cada cuatro adultos sedados después de cirugía cardiaca en la unidad de cuidados intensivos post- quirúrgica y cuatro enfermeras en el lado de la cama , y en cuatro puntos : el escenario A , sedación por inhalación sin sistema de extracción de gas o contrafluran como un escenario de referencia ; escenario B, la aplicación de un sistema de extracción de gas al ventilador ; escenario C , utilizando contrafluran y escenario 0 , realizando intravenosa sedación aislamiento. Concentraciones de sevoflurano fueron medidas en la zona de respiración de las enfermeras durante el cuidado del paciente, y en el 1,5 y 8 m desde el ventilador utilizando difusivos insignias monitor pasivo. Resultados Todas las insignias correspondientes a la zona de respiración de las enfermeras estaban por debajo de 2 ppm. Los niveles de sevoflurano detectado utilizando sistemas de prevención fueron más bajos que en la situación de control. Sólo se encontró un empeño superior a 2 ppm, correspondiente al monitor colocado más cerca de la salida de gas del ventilador en el escenario A concentraciones traza de sevoflurano fueron encontrados en el escenario 0 durante la sedación intravenosa. Conclusiones: La administración de sevoflurano a través del sistema AnaConDa ® durante la sedación por inhalación en las unidades de cuidados intensivos postquirúrgicos es seguro para los trabajadores de la salud, pero los sistemas de extracción de gas o sistemas de evacuación, tales como CONTRAfluran ™ debe ser usado para reducir la exposición ocupacional tanto como sea posible (AU)

Health worker exposure risk during inhalation sedation with sevoflurane using the (AnaConDa®) anaesthetic conserving device.

INTRODUCTION AND OBJECTIVE: Occupational exposure to sevoflurane should not exceed 2 ppm. During inhalation sedation with sevoflurane using the anaesthetic conserving device (AnaConDa(®)) in the post-anaesthesia care unit, waste gases can be reduced by gas extraction systems or scavenging devices such as CONTRAfluran™. However, the efficacy of these methods has not been clearly established. To determine the safest scenario for healthcare workers during inhalation sedation with sevoflurane in the post-surgical intensive care unit. MATERIALS AND METHODS: An experimental study on occupational exposure was conducted in a post-cardiothoracic care unit during March-August 2009. The measurements were performed in four post-cardiac surgery sedated adults in post-surgical intensive care unit and four nurses at the bedside, and at four points: scenario A, inhalation sedation without gas extraction system or contrafluran as a reference scenario; scenario B, applying a gas extraction system to the ventilator; scenario C, using contrafluran; and scenario 0, performing intravenous isolation sedation. Sevoflurane concentrations were measured in the nurses' breathing area during patient care, and at 1.5 and 8 m from the ventilator using diffusive passive monitor badges. RESULTS: All badges corresponding to the nurses' breathing area were below 2 ppm. Levels of sevoflurane detected using prevention systems were lower than that in the control situation. Only one determination over 2 ppm was found, corresponding to the monitor placed nearest the gas outlet of the ventilator in scenario A. Trace concentrations of sevoflurane were found in scenario 0 during intravenous sedation. CONCLUSIONS: Administration of sevoflurane through the AnaConDa(®) system during inhalation sedation in post-surgical intensive care units is safe for healthcare workers, but gas extraction systems or scavenging systems, such as CONTRAfluran™ should be used to reduce occupational exposure as much as possible.