Transfusion-free anesthetic management for open heart surgery in a neonate -A case report-

Lee, Jung Min; Byon, Hyo-Jin; Kim, Jin‐Tae; Kim, Hee‐Soo; Kim, Chong Sung

doi:10.4097/kjae.2010.59.s.s141

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…For example, without focusing on hemodynamic optimization, McCartney et al . were able to show that the abovementioned therapeutic actions were already associated with an improved clinical outcome after cardiac surgery of JWs [ 11 – 13 ]. Also, several case reports have supported preoperative EPO administration and blood-saving surgical techniques [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

The use of artificial intelligence and machine learning monitoring to safely administer a fluid-restrictive goal-directed treatment protocol to minimize the risk of transfusion during major spine surgery of a Jehovah’s Witness: a case report

et al. 2022

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Background The Hypotension Prediction Index (HPI) displays an innovative monitoring tool which predicts intraoperative hypotension before its onset. Case presentation We report the case of an 84-year-old Caucasian woman undergoing major spinal surgery with no possibility for the transfer of blood products given her status as a Jehovah’s Witness. The hemodynamic treatment algorithm we employed was based on HPI and resulted in a high degree of hemodynamic stability during the surgical procedure. Further, the patient was not at risk for either hypo- or hypervolemia, conditions which might have caused dilution anemia. By using HPI as a tool for patient blood management, it was possible to reduce the incidence of intraoperative hypotension to a minimum. Conclusions In sum, this HPI-based treatment algorithm represents a useful application for the treatment of complex anesthesia and perioperative patient blood management. It is a simple but powerful extension of standard monitoring for the prevention of intraoperative hypotension.

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Section: Discussionmentioning

confidence: 99%

The use of artificial intelligence and machine learning monitoring to safely administer a fluid-restrictive goal-directed treatment protocol to minimize the risk of transfusion during major spine surgery of a Jehovah’s Witness: a case report

et al. 2022

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“…Platelets count values showed a signifi cant decrease post CPB for all groups (p<0.01 for studied groups and groups IC, IIC and IIICB, and p<0.02 for group IIICA), but at 24hours postoperative groups IS, IIS and IIISA recover to insignifi cant lower than the pre-bypass values, where IIISB and control groups were not (Figure 10). Consequently, the calculated amounts of RBCs, plasma and total protein autotransfusion for groups IS, IIS and IIISA showed signifi cant high values compared with their control groups, in time were insignifi cant for group IIISB compared with group IIICB ( Table 2) hypothermia, hemodilution, and increase the blood vessels permeability because of the infl ammatory reaction due to surface contact activation, which leads to unfavorable alterations such as hemodynamics changes [13][14][15][16]. Total body water increases as a result of capillary permeability which often leads to tissue edema, followed by multiple organ dysfunctions principally in lungs, heart, and brain [17,18].…”

Section: Data Statistical Analysismentioning

confidence: 99%

Blood conservation protocol based on modified ultrafiltration towards bloodless pediatric surgery

Saleh¹

2020

Arch Clin Hypertens

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Background: Cardiopulmonary Bypass (CPB) application may cause severe hemodilution and an acute systemic infl ammatory response syndrome, especially with blood components transfusion. Multi-function circuit of cardioplegia delivery, conventional ultrafi ltration, and modifi ed ultrafi ltration was advocated to reverse the CPB hemodilution and conserve patient's blood through a blood conservation protocol. Methods: Retrospectively, 600 pediatric were randomly and equally distributed into six studied (S) and control (C) groups. Groups had been classifi ed according to weights as following; 30 kg≥ groups IS and IC >20 kg≥ groups IIS and IIC >10 kg≥ groups IIIS and IIIC ≥3kg, only studied groups were treated with the blood conservation protocol. The fl uid management, blood components conservation, and pediatrics clinical outcome characteristics will be investigated in this study. Results: 100% achievements for zero fl uids balance and bloodless surgery for studied pediatrics of weights ≥6 kg with signifi cant autotransfusion amounts of RBCs, plasma and total protein (p<0.02). Studied pediatrics of weights <6 kg received a signifi cantly lesser amount of homologous packed red blood cells, fresh frozen plasma, platelets (p<0.05) and protein product (p<0.01) compared with control pediatrics. Studied groups showed a gradual increase in mean arterial pressure during modifi ed ultrafi ltration process, with signifi cant lesser collectively total dopamine dose (p<0.05 and p<0.02 for weights range of 30-6 kg and <6 kg respectevely). Signifi cant lower blood loss (p<0.01) and shorter intubation duration and ICU stay (p<0.05 for group IS and p<0.01 for groups IIS and IIIS) observed for the studied groups. Conclusion: The blood conservation protocol under investigation is a successful method using routine CPB unit components facilitating bloodless surgery for pediatric weights range of 6-30kg.

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“…think that a patient's status as a Jehovah's Witness need not preclude potentially live-saving cardiac operations [ 5 – 7 ]. Transfusion-free cardiac surgery is also performed in Jehovah's Witnesses’ neonates [ 8 , 9 ]. Some surgeons have declined to treat Jehovah's Witnesses because their stand on the use of blood products seemed to “tie the doctor's hands”, although many physicians have chosen to view the situation as only one more complication challenging their skills [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Surgery in Jehovah’s Witnesses – our experience

Trzciński¹,

Kujawski²,

Mik³

et al. 2015

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IntroductionSurgeons face a special challenge in treating Jehovah's Witnesses who refuse blood transfusion.AimTo present our surgical experience with this group of patients operated on in our department.Material and methodsA retrospective study of 16 unselected Jehovah's Witnesses patients was conducted between October 2004 and February 2012. We analysed gender, age, haemogram before and after surgery, types of surgery, postoperative complications and the need for blood transfusion, and/or other drugs stimulating erythrogenesis.ResultsEighty-one percent of patients were women; the average age of all patients was 57.3 years. Mean haemoglobin level, preoperative, postoperative, and on the day of discharge from hospital, was 12.5 g/dl, 9.7 g/dl, and 9.29 g/dl, respectively. Over the same time period, mean red blood cell count was 4.53 mln/µl, 3.58 mln/µl, and 3.37 mln/µl, respectively. Two out of 16 patients agreed to have blood transfusion. Drugs used for erythropoiesis stimulation included rEPO, ferrum, and folic acid. No surgical death was noted.ConclusionsWe found that abdominal surgery was safe in our small group of Jehovah's Witness patients. However, all Jehovah's Witness patients should be fully informed about the type of procedure and possible consequences of blood transfusion refusal. Two of our patients agreed to blood transfusion in the face of risk of death.

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Transfusion-free anesthetic management for open heart surgery in a neonate -A case report-

Cited by 4 publications

References 17 publications

The use of artificial intelligence and machine learning monitoring to safely administer a fluid-restrictive goal-directed treatment protocol to minimize the risk of transfusion during major spine surgery of a Jehovah’s Witness: a case report

The use of artificial intelligence and machine learning monitoring to safely administer a fluid-restrictive goal-directed treatment protocol to minimize the risk of transfusion during major spine surgery of a Jehovah’s Witness: a case report

Blood conservation protocol based on modified ultrafiltration towards bloodless pediatric surgery

Surgery in Jehovah’s Witnesses – our experience

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