Evaluation of acute normovolemic hemodilution in patients undergoing intracranial meningioma resection

Abstract

The aim of this study was to evaluate the safety of acute normovolemic hemodilution (ANH) for patients undergoing intracranial meningioma resection.Eighty patients (aged 48–65 years) with American Society of Anesthesiologists physical status I–II undergoing intracranial meningioma resection were included in this prospective observational study. The patients were randomly divided into group A (ANH group), which underwent a combination of ANH and intraoperative cell salvage (ICS), and group B (control group), which underwent ICS alone. The study parameters were recorded as baseline values before blood drainage (T0), after blood drainage (T1), and before (T2) and after (T3) retransfusion in group A. Whereas in group B, the same parameters were measured 10 minutes after anesthesia induction (T0), before surgery (T1), and before (T2) and after (T3) transfusion of autologous blood.When intraoperative blood loss was <2000 mL, the mean volume of homologous blood transfused in group A patients was 100.8 ± 82.3 mL, compared with the 190.0 ± 91.8 mL in group B. Reduction in homologous blood used in group A was statistically significant (P < .05). In group B, 15.1% patients received homologous blood, whereas only 5.9% patients received homologous blood in group A. The difference in heart rate between both groups at different time points was statistically nonsignificant (P > .05). The mean hemoglobin and hematocrit levels at T1 and T2 in group A were lower than in group B (P < .05). The prothrombin time and activated partial thromboplastin time in both groups were prolonged significantly after T2 (all P < .05), but were all within normal range. There were no significant differences in postoperative hospital stay, mortality, and postoperative infection between the 2 groups.For patients undergoing excision of intracranial meningioma, ANH is an effective procedure to reduce the need for allogeneic transfusions.

Effects of Magnesium Sulfate on Intraoperative Blood Loss and Anesthetic Requirement in Meningioma Patients Undergoing Craniotomy with Tumor Removal: A Prospective Randomized Study

“…From previous studies, the intracranial meningioma resection had mean estimated blood loss at 965.2 ± 356 mL. 5 We expected that magnesium could reduce blood loss approximately 25% or 724 ± 356 mL, which was considered clinically significant. The sample size was calculated by nQuery program (two independent means) with α error 0.05 and study power of 80% and study population was 35 patients per group.…”

“…Intraoperative bleeding can be reduced by good controlling of blood pressure or preventing hypertensive episodes during various surgical stimuli with various agents such as β-blockers, nitroglycerine, sodium nitroprusside, high doses of potent inhaled anesthetics, α 2 agonists, and magnesium sulfate. 4 5 6 7 8…”

“…3 Intraoperative bleeding can be reduced by good controlling of blood pressure or preventing hypertensive episodes during various surgical stimuli with various agents such as βblockers, nitroglycerine, sodium nitroprusside, high doses of potent inhaled anesthetics, α 2 agonists, and magnesium sulfate. [4][5][6][7][8] Magnesium is a calcium antagonist, acting against calcium inflows of vascular smooth muscle, leading to systemic vasodilation. Magnesium also blocks catecholamine release at adrenergic nerve endings.…”

Papel da hemodiluição normovolêmica aguda na taxa de transfusão de sangue homólogo nos pacientes submetidos a tratamento cirúrgico de escoliose

“…Em 25 crianças submetidas a cirurgias oncológicas de grande porte com o uso de hemodiluição, a transfusão sanguínea foi necessária em apenas 6 dos pacientes (SCHALLER et al, 1983). Em outro estudo observacional prospectivo realizado em pacientes submetidos à excisão de meningioma intracraniano comprovou-se que a HNA é um procedimento eficaz para reduzir a necessidade de transfusões alogênicas (YANG et al, 2017). Também foi relatado um caso de uma criança com 8 meses de idade, com volemia estimada de 800 ml, submetida a uma extensa cirurgia abdominal na qual se realizou HNA e foram retirados 160 ml de sangue, produzindo um hematócrito de 17%.…”

“…Muitos autores que criticam a HNA afirmam que é um procedimento complicado e que prolonga o tempo anestésico (BRYSON;LAUPACIS;WELLS, 1998;HOHN et al, 2002). Apesar disso, ainda não existe um consenso e, em um estudo observacional prospectivo realizado em pacientes submetidos à excisão de meningioma intracraniano, sugeriu-se que a HNA é um procedimento eficaz e que não houve diferenças significativas no tempo de internação pós-operatória, mortalidade e infecção pós-operatória (YANG et al, 2017). Uma meta-análise de 63 ensaios randomizados controlados (3819 pacientes) mostrou sete estudos (n = 263) que compararam o tempo de internação para pacientes com ou sem HNA e concluiu que o tempo de internação hospitalar foi semelhante, entretanto, o próprio autor sugere que a amostra utilizada foi pequena, podendo limitar a significância do estudo em detectar pequenas diferenças nos desfechos secundários como o tempo de internação e a taxa de eventos adversos apresentados (ZHOU et al, 2015).…”