Management of severe perioperative bleeding

Abstract

The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient's tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees and individual expert members of the ESA. Electronic databases were searched without language restrictions from the year 2000 until 2012. These searches produced 20 664 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks and the link was sent to all ESA members. Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

“…Current practice guidelines support incorporating near‐patient coagulation testing into blood management algorithms for cardiac surgery 24, 25, 26. However, these guidelines do not distinguish between the use of near‐patient tests to inform treatment selection after patients develop severe bleeding, and the use of pre‐emptive testing to predict bleeding and to direct preventative treatments.…”

“…Blood management algorithms incorporating near‐patient tests are recommended in US and European practice guidelines24, 25, 26, and are used widely 27. However, there is poor consensus about the best algorithm design, particularly whether near‐patient tests should be performed in response to severe bleeding, or whether there is additional value in pre‐emptive testing to help prevention of bleeding.…”

Procedimientos endoscópicos y terapias antitrombóticas, una visión actual

“…La Sociedad Europea de Anestesiología establece que no es necesario suspender los NACO para endoscopias altas ni para colonoscopias, incluso si está programada la realización de biopsias (16).…”

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

“…A variety of approaches have been employed to reduce perioperative blood loss [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67]. The development of protocols involves multidisciplinary collaboration between surgeons, anesthesiologists, hematologists, transfusion medicine and pharmacy.…”