Acute Normovolemic Hemodilution: A Critical Evaluation of Its Safety and Utility in Pediatric Patients

Wong, Edward C.C.

doi:10.1111/j.1778-428x.2004.tb00113.x

Cited by 3 publications

(5 citation statements)

References 124 publications

(153 reference statements)

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“…ANH has been described for both adult and pediatric surgeries in which high blood loss is anticipated 26,27 . Several studies describe successful use in pediatric cardiac surgery, where the concept of hemodilution is more familiar, given the use of clear prime cardio pulmonary bypass cicuits 28–30 . In a 1991 study from Zurich, ANH was used in 30 children undergoing spinal fusion and was associated with a 75% reduction in transfusion 31 .…”

Section: Discussionmentioning

confidence: 99%

“…ANH may be unsafe in severely dehydrated patients, patients with significant baseline anemia or other hematologic disorders such as sickle cell anemia, infants with small blood volumes, and patients with cardiac or pulmonary disease. Finally, ANH is more labor‐intensive for the anesthesia team than traditional transfusion, and requires additional expertise, equipment, preparation, and venous access as described below 30 …”

Section: Discussionmentioning

confidence: 99%

“…26,27 Several studies describe successful use in pediatric cardiac surgery, where the concept of hemodilution is more familiar, given the use of clear prime cardio pulmonary bypass cicuits. [28][29][30] In a 1991 study from Zurich, ANH was used in 30 children undergoing spinal fusion and was associated with a 75% reduction in transfusion. 31 Notably, they targeted a hemodilution goal of 20%-25%, and withheld transfusion until a Hct of 12%-14%.…”

Section: Anesthetic Pbm Strategiesmentioning

confidence: 99%

“…Finally, ANH is more labor-intensive for the anesthesia team than traditional transfusion, and requires additional expertise, equipment, preparation, and venous access as described below. 30 While there is no standardized approach to pediatric ANH, generally blood is removed in proportion with the patient's starting Hct, and replaced with crystalloid or colloid to achieve a goal Hct of 20%-30%. Exact recommendations for hemodilution targets and fluid replacement ratios should take into account the individual patient and surgical characteristics, and vary widely between patients and surgeries.…”

Section: Anesthetic Pbm Strategiesmentioning

confidence: 99%

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Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management

Longacre

Seshadri

Adil

et al. 2023

Pediatric Anesthesia

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Background: Juvenile nasopharyngeal angiofibromas are one of the most enigmatic, bloody tumors encountered by otorhinolarygnologists, head and neck surgeons, neurosurgeons, and anesthesiologists. Juvenile nasopharyngeal angiofibromas are rare, benign, highly vascular tumors with a propensity towards aggressive local invasion. Surgery, open or endoscopic, to remove the growth is the primary treatment of choice for Juvenile nasopharyngeal angiofibromas. Historically, surgical resection was associated with massive, rapid blood loss, traditionally managed by blood product transfusion and deliberate hypotension. Preventative management employing multimodal blood conservation strategies should be an essential standard of perioperative care for patients with Juvenile nasopharyngeal angiofibromas. Methods:We describe a contemporary and comprehensive approach in the management of patients with high grade Juvenile nasopharyngeal angiofibromas. This includes surgical strategies such as preemptive external carotid artery embolization, endoscopic surgical approach, and staged operations, as well as anesthetic strategies including antifibrinolytic therapy and acute normovolemic hemodilution. These surgeries, once synonymous with massive transfusion, may potentially be performed without allogeneic blood transfusion, or deliberate hypotension.Aims: Using a case series, the authors introduce a contemporary approach to multimodal, multidisciplinary blood conservation strategies for Juvenile nasopharyngeal angiofibromas surgery. Results:Here in the authors report on an updated contemporary perioperative clinical approach to patients with Juvenile nasopharyngeal angiofibromas. From an anesthetic perspective, we describe the successful use of normal hemodynamic goals, restrictive transfusion strategy, antifibrinolytic therapy, autologous normovolemic hemodilution, and early extubation in the care of three adolescent males with highly invasive tumors. We demonstrate that new surgical and anesthetic strategies have yielded a significant decrease in intraoperative blood loss and eliminated the need for transfusion of autologous red blood cells, which enable improved outcomes. Conclusions:The perioperative approach to elective surgery for Juvenile nasopharyngeal angiofibromas management is presented from a multidisciplinary patient blood management perspective.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Anesthetic Pbm Strategiesmentioning

confidence: 99%

Section: Anesthetic Pbm Strategiesmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management

Longacre

Seshadri

Adil

et al. 2023

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…Safety of ANH in paediatric patients is well described. [ 3 ] The major concerns include the possibility of haemodynamic instability during ANH and the cost and resources required for ICS. Although PBM is well established in adults, the evidence in paediatric patients is still inadequate.…”

mentioning

confidence: 99%