engleski

Blood managemet strategies in vertebral surgery

Spine and spinal deformity surgery, may be associated with high perioperative blood loss.Adverse effects of allogeneic blood transfusions have been shown for most surgical fields including orthopedic surgery. Several efforts have been made to increase the preoperative red blood cell (RBC) mass, to reduce the intraoperative blood loss, and to use restrictive transfusion triggers in order to minimize or avoid RBC transfusions. Measures to reduce intraoperative blood loss include new surgical techniques, use of cell salvage where possible, bedside coagulation management with point-of-care devices, substitution of coagulation factors, antifibrinolytic agents, and desmopressin, induced hypotension, and avoidance of hypothermia. Controlling blood loss during scoliosis surgery is a challenge to both the surgeon and the anesthesiologis. Both have other concerns during the procedure. In addition to minimizing blood loss, the surgeon's primary goal is a safe, successful arthrodesis. The anesthesiologists technique must allow intraoperative assessment of spinal cord function either by SEP, a wake-up test, or both. Successful control of blood loss allows the patient to receive a better operation and significantly reduces the patient's risk of acquiring a transfusion-related illness. By combining surgical and anesthetic techniques that minimize blood loss with the use of autotransfusion, it should now be possible to complete a routine posterior spinal fusion without using allogeneic blood transfusions. Surgical efforts should include careful preoperative planning, positioning with the abdomen hanging free, use of topical hemostatic egents, and decortication late in the procedure.Preoperatively donated autogeneic blood or reclaimed red cells from suction can take the place of allogeneic transfusions. Blood loss during scoliosls surgery correlates closely with left ventriculrr stroke work index (LVSWI), a measure of blood flow calculeted from systemic vascular resistance, cardiac output and heart rate. All of these parameters are under the anesthesiologist's control, making him the primrry determinant of blood loss in scoliosis surgery. Induced hypotensive anesthesia may be ineffective in confiolling blood loss if the cardiac output or heart rate is high. Sevorane, commonly used hypotensive agent is not very useflul for scoliosis surgery because spinal cord monitoring and wake-up testing are not possible. Rebound hypertension has been noted with the use of sodium nitroprusside. Trimethaphan works well clinically but experimentally it reduces spinal cord blood flow, which may increase the risk of spinal cord injury. In order to reduce the risk of excessive blood loss and unnecessary blood transfusions, strategies such as Patient Blood Management including goal-directed coagulation management have been developed.

blood strategy, surgery, haemorhage, transfusion

nije evidentirano