Optimizing preoperative haemoglobin with intravenous iron

Abstract

We know that metaraminol is a sympathomimetic amine which acts on the a1-adrenergic receptor with some stimulation of the b-adrenergic receptors. The combination of increased systemic vascular resistance and increased contractility results in an elevation in arterial pressure. However, the effect of metaraminol (or other sympathomimetics) in patients with Takotsubo cardiomyopathy may be less predictable due to the dysfunctional myocardial response to catecholamine stimulation. Indeed, there is evidence to suggest a paradoxical negative inotropic effect of sympathomimetic amines in these patients which appears to be dosedependent. 4 This finding was corroborated by Rathakrishnan and Lee, 5 who also observed that augmenting already high concentrations of circulating catecholamines with exogenous compounds may cause accelerated deterioration. Limited evidence suggests that using agents which have no action on the b-adrenergic receptors may be safer in these patients. 6 This interesting case demonstrates that caution is advised when using sympathomimetic drugs in people with Takotsubo cardiomyopathy. Furthermore, avoidance of agents which act on the b-adrenergic receptors may be a safer option for these patients.

Optimizing preoperative hemoglobin in major orthopaedic surgery using intravenous iron with or without erythropoietin. An epidemiologic study

“…29 The effectiveness of iron sucrose in increasing Hb also depends on the accuracy of the iron deficiency anemia diagnosis. 30 Hb is unlikely to increase in patients with good iron stores and good functional status. In young patients, iron deficit due to metrorrhagia is easily diagnosed 31 and responds well to treatment.…”

Optimización de la hemoglobina preoperatoria en cirugía ortopédica mayor utilizando hierro intravenoso con o sin eritropoyetina. Estudio epidemiológico

“…La efectividad del hierro-sacarosa para aumentar la Hb también depende del grado de precisión con el que se diagnostica la anemia por déficit de hierro 30 . Es improbable que ocurra un aumento de Hb en aquellos pacientes con reservas de hierro suficientes y un buen estado funcional.…”

Blood Transfusion after Total Knee Arthroplasty; Comparison of Drainage versus Non-Drainage

“…Studies have shown that oral ferrous sulphate is useful for correcting iron deficiency in non-anaemic patients [15]. A recent study has suggested that oral ferrous sulphate does not increase preoperative Hb levels in patients planned for elective total hip or knee arthroplasty [16], however intravenous iron replacement was found to be effective in increasing preoperative Hb in these patients according to another recent study [17].…”