Anesthesia in Cases of Poor Surgical Risk

Adams, Richard N.; Lundy, John S.

doi:10.1097/00000542-194209000-00032

Cited by 44 publications

(11 citation statements)

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“…The World Health Organization defines a healthy haemoglobin level as 13 grams per decilitre (g dL −1 ) of blood or higher in men, and 12 g dL −1 in women. Historically, doctors would consider a transfusion when a patient's haemoglobin fell below 10 g dL −1 , a trigger that was proposed in a 1942 paper 3 .…”

Section: Transfusion Triggersmentioning

confidence: 99%

Evidence-based medicine: Save blood, save lives

Anthes¹

2015

Nature

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Section: Transfusion Triggersmentioning

confidence: 99%

Evidence-based medicine: Save blood, save lives

Anthes¹

2015

Nature

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“…In 1942 an arbitrary minimally acceptable hemoglobin level of 10 g/dl was proposed for patients requiring general anesthesia and that level became a standard for all hospitalized patients [20]. During the 1970s this "transfusion trigger" was questioned as the rapid growth of cardiac and orthopedic surgery put increasing demands on limited transfusion resources [21].…”

Section: Discussionmentioning

confidence: 99%

Accurate Measurement of Intraoperative Blood Loss during Wound Excision Leads to More Appropriate Transfusion and Reduced Blood Utilization

Bernal¹,

Castro²,

Burton³

et al. 2017

J Anesth Clin Res

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Objective: To determine if accurate measurement of surgical blood loss using a novel device that photographs surgical sponges and calculates their hemoglobin content affects transfusion practice. Methods:We retrospectively compared transfusion events for patients having wound excisions using visual estimation of blood loss (traditional group; n=178) to similar events following device implementation (study group; n=221). Results:The study group (age 43 ± 22 years, body surface area burn 11.2 ± 18.0%, excision area 624, IQR 757 cm 2 , preoperative hemoglobin 10.7 ± 2.4 g/dl) did not differ significantly from the traditional group (age 42 ± 23 years (p=0.527), body surface area burn 12.2 ± 22.6% (p=0.661), excision area 753, IQR 505 cm 2 (p=0.485), and preoperative hemoglobin 10.7 ± 2.2 g/dl (p=0.833).Postoperative transfusion rates were significantly lower in the study group (6.3% vs. 12.9%; p=0.024), as was the proportion of transfused patients undergoing multiple transfusion events (13.0% vs. 34.9%; p=0.01). Red cell dose (units/transfused patient) was less in the study group compared to the traditional group (1.83 ± 1.09 vs. 2.51 ± 1.61 units; p=0.021).In a subgroup of patients requiring excision of burned areas ≥ 1,000 cm 2 (traditional group n=36, study group n=43), these differences were more significant. The postoperative transfusion rate fell from 44.4% to 14.0% (p=0.003), as did the percent of transfused patients experiencing multiple transfusion events (50.0% vs. 14.3%; p=0.004).Conclusions: Accurate measurement of surgical blood loss was associated with a decrease in transfusions suggesting more timely decision making. Informed transfusion decisions may result in fewer transfusions by avoiding over-transfusion related to both excessive hemodilution and inaccurate visual estimates.

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“…Transfusion has become a cornerstone in the treatment of the critically ill since the founding of the first blood banks heralded its growing use in the 1930s. The indications for transfusion, such as the formerly widely accepted "10/30" rule, 32 did not have basis in firm data. Transfusion practice had remained relatively unchallenged, undergoing systematic scrutiny only recently.…”

Section: Discussionmentioning

confidence: 99%

Leukoreduction is Associated with a Decreased Incidence of Late Onset Acute Respiratory Distress Syndrome after Injury

Plurad

Belzberg

Schulman

et al. 2008

The American Surgeon

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Transfusions are known to be associated with Acute Respiratory Distress Syndrome (ARDS). Transfusion of leukoreduced products may be associated with a decreased incidence of late posttraumatic ARDS (late ARDS). Data from ventilated and transfused trauma patients were analyzed. Key variables in the first 48 hours of admission were studied for their associations with late ARDS and examined for changes over the 6 year study period. Late ARDS developed in 244 of the 1488 patients studied (16.4%). The incidence in patients given nonleukoreduced (NLR) product was 30.4 per cent (75/247) versus 13.6 per cent (169/1241) for patients not exposed [2.77 (2.02–3.73), P < 0.001]. Exposure to NLR products (50.9% in 2000 vs 1.9% in 2005) and incidence of ARDS (26.3% in 2000 vs 6.3% in 2005) significantly decreased. Treatment variables independently associated with late ARDS were NLR product exposure, Total Parenteral Nutrition exposure, Peak Inspiratory Pressure ≥ 30 mm Hg, fluid balance ≥ 2 liters at 48 hours, and transfusion of ≥ 10 units of any product. NLR product exposure has an association with an increased incidence of late onset posttraumatic ARDS which is independent of large volume transfusions. Leukoreduction should be routinely included in an overall treatment strategy to furthermore mitigate this complication in critically ill trauma patients.

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Anesthesia in Cases of Poor Surgical Risk

Cited by 44 publications

References 0 publications

Evidence-based medicine: Save blood, save lives

Evidence-based medicine: Save blood, save lives

Accurate Measurement of Intraoperative Blood Loss during Wound Excision Leads to More Appropriate Transfusion and Reduced Blood Utilization

Leukoreduction is Associated with a Decreased Incidence of Late Onset Acute Respiratory Distress Syndrome after Injury

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