No abstract

Venous bupivacaine plasma concentrations were measured in six neonates and infants aged 4 days to 3.9 mo (mean, 2.1 mo) and 10 infants and children aged 9 mo to 6 yr (mean, 3.1 yr) after administration of an initial bolus of 0.5 mL/kg bupivacaine 0.25%, followed by a continuous infusion of local anesthetic (0.25 mL.kg-1.h-1) over a period of 4 h (first hour: bupivacaine 0.25%, then reduced to 0.125%). Plasma concentrations of local anesthetic measured at 180 min and 300 min after beginning of bupivacaine administration were significantly higher in younger infants when compared to older infants and children (180 min: 0.67 +/- 0.24 micrograms/mL [0.25-0.97] vs 0.27 +/- 0.11 micrograms/mL [0.19-0.55], P < 0.01; 300 min: 0.86 +/- 0.36 micrograms/mL [0.35-1.25] vs 0.34 +/- 0.12 micrograms/mL [0.18-0.57], P < 0.01). The results of our study show that despite applying the same dosage of epidural bupivacaine significantly higher plasma concentrations were seen after short periods of continuous infusion in infants up to 4 mo than in children older than 9 mo.

Autologous transfusion does not provide a cheaper alternative to transfusion of allogeneic blood. The cost of producing a unit of autologous blood in our centre is currently about twice the cost of an equivalent allogeneic unit. This difference is due to the staffing and transport costs of the autologous clinics, which are located at several hospitals within the region to allow easy access for patients. If the programme were to expand, allowing venesection of more donors at each clinic, the collection cost per unit would fall.Unused autologous units were not made available for any other recipient. Most of our autologous donors were taking drugs which would make their blood donation unacceptable for allogeneic use. Also, most autologous units were transfused, those not transfused being held for potential autologous use until expiry or patient discharge. Thus very few units would ultimately be suitable for crossover and procedures for their retrieval are not justified.We have shown the feasibility of a regional autologous donation programme coordinated by a blood transfusion centre. Main factors which prevented autologous donation were failure to attend the clinic, anaemia, and cardiovascular disease. The main factors which restricted the provision of blood by those who donated were late referral and post-donation anaemia. The aim of avoiding allogeneic blood transfusion was achieved by most patients who donated blood.

No abstract