Perioperative red blood cell transfusion in orofacial surgery

Abstract

In the field of orofacial surgery, a red blood cell transfusion (RBCT) is occasionally required during double jaw and oral cancer surgery. However, the question remains whether the effect of RBCT during the perioperative period is beneficial or harmful. The answer to this question remains challenging. In the field of orofacial surgery, transfusion is performed for the purpose of oxygen transfer to hypoxic tissues and plasma volume expansion when there is bleeding. However, there are various risks, such as infectious complications (viral and bacterial), transfusion-related acute lung injury, ABO and non-ABO associated hemolytic transfusion reactions, febrile non-hemolytic transfusion reactions, transfusion associated graft-versus-host disease, transfusion associated circulatory overload, and hypersensitivity transfusion reaction including anaphylaxis and transfusion-related immune-modulation. Many studies and guidelines have suggested RBCT is considered when hemoglobin levels recorded are 7 g/dL for general patients and 8-9 g/dL for patients with cardiovascular disease or hemodynamically unstable patients. However, RBCT is occasionally an essential treatment during surgeries and it is often required in emergency cases. We need to comprehensively consider postoperative bleeding, different clinical situations, the level of intra- and postoperative patient monitoring, and various problems that may arise from a transfusion, in the perspective of patient safety. Since orofacial surgery has an especially high risk of bleeding due to the complex structures involved and the extensive vascular distribution, measures to prevent bleeding should be taken and the conditions for a transfusion should be optimized and appropriate in order to promote patient safety.

Developing a predictive risk score for perioperative blood transfusion: a retrospective study in patients with oral and oropharyngeal squamous cell carcinoma undergoing free flap reconstruction surgery

“…The baseline clinical features of the patients are listed in Table 1. A total of 101 patients (26%) received blood transfusions, with 28 patients (7%) requiring 4 or more units {median [interquartile range] =2 [2][3][4] units/patient}. Of the 101 patients requiring blood transfusions, 35.6% (36 of 101) were transfused during the operation, 5.9% (6 of 101) received blood within 24 hours before surgery, and 58.4% (59 of 101) received blood within 24 hours after surgery.…”

“…This is partly due to an especially high risk of substantial blood loss because of the complex structures involved and the extensive vascular distribution in the area. Efforts to prevent massive bleeding may be accompanied by appropriate transfusion in order to promote the safety of patients (1,2). Blood transfusion is indispensable for ensuring oxygen transfer to hypoxic tissues and plasma volume expansion during bleeds.…”

“…However, allogeneic blood transfusions may have significant deleterious effects on the short-and longterm prognosis of patients undergoing surgery for head and neck cancer. Blood transfusions may be complicated by transfusion-transmitted diseases and other noninfectious transfusion-related risks (2,3). For example, the immunosuppressive effects of blood transfusions may promote tumor cell growth and postoperative tumor recurrence (4,5).…”

Predictors of Red Blood Cell Transfusion in Bimaxillary Orthognathic Surgery: A Retrospective Study

“…If there is a lot of bleeding during surgery, intraoperative RBC transfusion is inevitable, but it can cause several complications 6 . RBC transfusions are associated with mortality and a significant increase in the length of postoperative hospital stay 4 , 5 .…”

Efficacy of minimal invasive cardiac output and ScVO2 monitoring during controlled hypotension for double-jaw surgery

“…Orofacial area has complex vascularization and is susceptible to excessive bleeding during orthognathic surgery [6]. For double jaw surgery, CH has remained a common method of anesthesia owing to decreased bleeding and related complications [1,4,5,7].…”