Normovolemic Hemodilution : An Effective Method for Limiting Postoperative Transfusion Following Complex Lumbar Spinal Decompression with Instrumented Fusion

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概要

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• The goal of "bloodless surgery" or the normovolemic hemodilution (NH) technique is to minimize intraoperative blood loss and to limit or eliminate preoperative blood donation and postoperative homologous transfusion. Risks associated with autologous or homologous blood transfusion include receiving the wrong unit, the potential for predonated blood contamination or infection in homologous blood, the progressive crenation of red corpuscles maintained over weeks prior to surgery, and the loss of coagulation factors and platelets. The NH technique was utilized in 40 patients averaging 49 years of age undergoing multilevel lumbar laminectomies with instrumented fusions. All patients had normal preoperative cardiac stress tests. Early in our series, 6 patients predonated from 1-3 units of blood ; the latter 34 patients did not. Immediately prior to surgery, an average of 563.5cc of autologous blood was removed after which patients received an average of 4585mL of crystalloid. Preoperative hematocrits averaged 41. Decompressive laminectomies (average 3.6 levels) and fusions (average 1.3 levels) required an average of 5.0 hours of operating time. Intraoperative blood loss (average 719cc) resulted in average postoperative hematocrits of 27.5 five days postoperatively. Only 12 (30%) of 40 patients had enough autologous blood in the cell saver (average of 303mL, range 100cc-680mL) to warrant reinfusion. Utilizing the normovolemic hemodilution technique, only 6 patients (15%) required postoperative homologous blood transfusions. For those wishing to predonate blood, more complete screening would allow unused units to be returned to the blood bank for use in the overall population.

• 日本脊髄外科学会の論文
• 2004-11-30

著者

• Epstein Nancy

  Department Of Neurological Surgery Albert Einstein College Of Medicine

• Peller Abraham

  Department Of Anesthesia Winthrop University Hospital

• Greco Joseph

  Department Of Anesthesia Winthrop University Hospital

• DECROSTA Don

  Department of Anesthesia, Winthrop University Hospital

• SCHMIGELSKI Carl

  Department of Anesthesia, Winthrop University Hospital

• Epstein Nancy

  The Albert Einstein College of Medicine, Bronx, NY, and Attending in Neurosurgery, Winthrop Universi

• Peller Abraham

  Attending Department of Anesthesia, Winthrop University Hospital

• Boutros Ashray

  State University of New York, Brooklyn, NY, and Attending Department of Anesthesia, Winthrop Univers

• Koreff Jeff

  State University At Stony Brook, NY and Attending Department of Anesthesia, Winthrop University Hosp

• DeCrosta Don

  State University At Stony Brook, NY and Attending Department of Anesthesia, Winthrop University Hosp

• Schmigelski Carl

  Attending Department of Anesthesia, Winthrop University Hospital

• Greco Joseph

  State University of New York, Brooklyn, NY, and Attending Department of Anesthesia, Winthrop Univers

• Koreff Jeff

  Department Of Anesthesia Winthrop University Hospital

• Epstein Nancy

  The Albert Einstein College Of Medicine Bronx Ny And Attending In Neurosurgery Winthrop University H

• Boutros Ashray

  Department Of Anesthesia Winthrop University Hospital

• Schmigelski Carl

  Department Of Anesthesia Winthrop University Hospital

• Epstein Nancy

  The Albert Einstein College Of Medicine

• Epstein Nancy

  Department of Neurological Surgery, Albert Einstein College of Medicine

関連論文

• Impact of Intraoperative Normovolemic Hemodilution on Transfusion Requirements for 68 Patients Undergoing Lumbar Laminectomies With Instrumented Posterolateral Fusion
• Normovolemic Hemodilution : An Effective Method for Limiting Postoperative Transfusion Following Complex Lumbar Spinal Decompression with Instrumented Fusion
• Lumbar Laminectomy for the Resection of Synovial Cysts and Coexisting Lumbar Spinal Stenosis or Degenerative Spondylolisthesis : An Outcome Study
• Intermittent Pneumatic Compression Stocking Prophylaxis Against Deep Venous Thrombosis in Anterior Cervical Spinal Surgery : A Prospective Efficacy Study in 200 Patients and Literature Review
• Posterior Cervical Fusion Utilizing A Modified "Screwless" Vertex System : A Preliminary Report in 8 Patients
• A Comparative Analysis of Plate/Graft Failure with Correction Following Circumferential Cervical Spinal Surgery
• Complications and Outcome in Dynamic Plated Single Level Anterior Corpectomy and Fusion Including Two Level Complete Diskectomies
• Surgeon Choices, and the Choice of Surgeons, Affect Total Hospital Charges for Single-Level Anterior Cervical Surgery

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