Red blood cell transfusion in perioperative pediatric anesthesia: a survey of current practice in Germany

Wittenmeier, Eva; Troeber, Claudius; Zier, Ulrike; Schmidtmann, Irene; Pirlich, Nina; Becke, Karin; Piepho, T.

doi:10.1111/trf.14581

Cited by 10 publications

(6 citation statements)

References 36 publications

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“…Surprisingly, the transfusion triggers in this analysis were found to be lower than suggested by the existing guidelines 11–13 . A survey published in 2018 addressing current clinical practice in Germany emphasises this existing discrepancy 22 . A 2011 Cochrane review analysed four randomised controlled studies comparing low versus high Hb thresholds in very premature infants requiring high levels of respiratory support.…”

Section: Discussionmentioning

confidence: 73%

“…[11][12][13] A survey published in 2018 addressing current clinical practice in Germany emphasises this existing discrepancy. 22 A 2011 Cochrane review analysed four randomised controlled studies comparing low versus high Hb thresholds in very premature infants requiring high levels of respiratory support. No differences were found in morbidity and mortality between patients subjected to low versus high Hb thresholds.…”

Section: Discussionmentioning

confidence: 99%

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Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe

Fuchs

Disma

Virág

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl −1 , distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN A multicentre observational study. SETTING The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks’ postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, ‘delta haemoglobin’ ( preprocedure – transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl −1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl −1 in week 2 and 8.0 [7.3 to 9.0] g dl −1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg −1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl −1 . Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02350348

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe

Fuchs

Disma

Virág

et al. 2021

European Journal of Anaesthesiology

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“…Haemoglobin values demonstrated a less permissive attitude compared with current published transfusion triggers, 33 but also mirror higher thresholds for premature neonates than older infants. 34,35 In contrast, temperature that triggered an intervention for hypothermia was well below 36 C.…”

Section: Continuedmentioning

confidence: 99%

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Disma¹,

Veyckemans²,

Virág³

et al. 2021

British Journal of Anaesthesia

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106

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Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n¼5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO 2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]¼1.16; 95% confidence interval [CI], 1.04e1.28

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“…Fluid resuscitation and blood products were given to maintain blood pressure and heart rate with the target to be as close to physiologically normal level. The transfusion trigger for pediatric neurosurgery is poorly defined, 7 and our institution uses Hb 7-8 to as the trigger, especially if the patient experiences hemodynamic instability. The patient was kept normothermic to prevent acidosis.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia Management in Massive Occipital Meningoencephalocele with Chiari III Malformation: A Case Report

Cahyadi,

Firdaus,

Angkasa

2024

IMCRJ

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Arnold-Chiari malformation is a displacement of the brain into the spinal canal, often leading to hemodynamic distress. Arnold-Chiari malformation type III (CM III) is a rare and severe type that requires early detection to prevent complications. We aim to report this rare presentation of CM III. A 16-month-old girl with a massive tumor of the occiput suspected to be a meningoencephalocele with CM III was referred to the neurosurgery department. The patient was assessed with class 3 American Society of Anesthesiologist classification, posed challenges due to a difficult airway and the presence of a meningoencephalocele. The patient was scheduled for an elective surgery. Preoperative, the patient was lethargic with an abnormal heart rate and blood pressure. Induction was performed while preserving spontaneous ventilation, but was assisted by an oropharyngeal airway due to a short neck and obesity. The patient later developed laryngospasm thus, muscle relaxant and propofol were administered. A rescue laryngeal mask airway was inserted due to desaturation. Intubation was performed with video laryngoscope. When the surgeon opened the cele and removed the cerebrospinal fluid, the blood pressure began to decline. Resection of brain tissue caused the patient started to bleed, fluid and blood products were administered. At the end of surgery, the patient had stable hemodynamics and was transferred to the pediatric intensive care for monitoring. In patients with massive occipital meningoencephalocele and CM III, anesthetic management requires smooth intubation and prevention of excessive manipulation of the cervical joint to prevent increased intracranial pressure. The patient was not extubated because the brainstem could not be sufficiently reduced coupled with significant autonomic dysfunction.

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Red blood cell transfusion in perioperative pediatric anesthesia: a survey of current practice in Germany

Abstract: Striking variability exists in practice of perioperative pediatric RBC transfusion. A specialized guideline for perioperative blood transfusion in children could be helpful to define and promote optimal pediatric RBC transfusion strategies.

Cited by 10 publications

References 36 publications

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Anesthesia Management in Massive Occipital Meningoencephalocele with Chiari III Malformation: A Case Report

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