Uncompensated Blood Loss Is Not Tolerated During Acute Normovolemic Hemodilution in Anesthetized Pigs

Schou, Henning; Kongstad, Lis; Perez-de-Sa, Valeria; Werner, Olof; Larsson, Anders

doi:10.1097/00000539-199810000-00009

Cited by 16 publications

(24 citation statements)

References 22 publications

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“…DO 2krit wird bei Hypovolämie bereits bei höheren Werten erreicht als während Normovolämie. Die Anämie-toleranz des Organismus ist während einer Hypovolämie reduziert [92].…”

Section: Intravasales Blutvolumenunclassified

Perioperative Anämietoleranz

Häbler

Meier²,

Pape³

et al. 2006

Anaesthesist

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The expected cost explosion in transfusion medicine (increasing imbalance between donors and potential recipients, treatment of transfusion-associated complications) increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient's physiologic tolerance to anemia enables 1) the tolerance of larger blood losses (loss of "diluted blood"), 2) the onset of transfusion to the time after surgical control of bleeding to be delayed and 3) the perioperative collection of autologous red blood cells. The present review article summarizes the mechanisms, influencing factors and limits of this natural tolerance to anemia and deduces the indication for perioperative red blood cell transfusion. Under strictly controlled conditions (anesthesia, normovolemia, complete muscular relaxation, hyperoxemia, mild hypothermia) extremely low hemoglobin concentrations [Hb <3 g/dl (<1.86 mmol/l)] are tolerated without transfusion by individuals with no cardiopulmonary disease. In the clinical routine these situations are limited to borderline situations e.g. unexpected massive blood losses in Jehovah's Witnesses or unexpected shortcomings in blood supply. The current recommendations coincide to the effect that perioperative red blood cell transfusion 1) is unnecessary up to a Hb concentration of 10 g/dl (6.21 mmol/l) even in older patients with cardiopulmonary comorbidity and 2) is only recommended in cases of Hb <6 g/dl (<3.72 mmol/l) in otherwise healthy subjects including pregnant women and children. Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.

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“…DO 2krit wird bei Hypovolämie bereits bei höheren Werten erreicht als während Normovolämie. Die Anämie-toleranz des Organismus ist während einer Hypovolämie reduziert [92].…”

Section: Intravasales Blutvolumenunclassified

Perioperative Anämietoleranz

Häbler

Meier²,

Pape³

et al. 2006

Anaesthesist

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“…Finally, we did not directly measure oxygen consumption but calculated it from the arterial mixed venous gradient. This method is an indirect method for oxygen consumption measurement that has been validated by others [75][76][77][78][79]. Notwithstanding these limitations, the present study demonstrates the benefits of whole body periodic acceleration treatment in a severe graded hemorrhagic shock model.…”

Section: Study Limitationsmentioning

confidence: 52%

Whole Body Periodic Acceleration (pGz) Improves Survival and Allows for Resuscitation in a Model of Severe Hemorrhagic Shock in Pigs

Bassuk

Arias

et al. 2010

Journal of Surgical Research

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“…DO 2krit wird bei Hypovolämie bereits bei höheren Werten erreicht als während Normovolämie. Die Anämieto-leranz des Organismus ist während Hypovolämie reduziert [78]. lischen Aortendrucks durch systemischen Widerstandsverlust.…”

Section: Normovolämieunclassified

Perioperatives Management bei Zeugen Jehovas

Häbler

Voß

2010

Anaesthesist

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The religious organization of Jehovah's Witnesses numbers more than 7 million members worldwide, including 165,000 members in Germany. Although Jehovah's Witnesses strictly refuse the transfusion of allogeneic red blood cells, platelets and plasma, Jehovah's Witness patients may nevertheless benefit from modern therapeutic concepts including major surgical procedures without facing an excessive risk of death. The present review describes the perioperative management of surgical Jehovah's Witness patients aiming to prevent fatal anemia and coagulopathy. The cornerstones of this concept are 1) education of the patient about blood conservation techniques generally accepted by Jehovah's Witnesses, 2) preoperative optimization of the cardiopulmonary status and correction of preoperative anemia and coagulopathy, 3) perioperative collection of autologous blood, 4) minimization of perioperative blood loss and 5) utilization of the organism's natural anemia tolerance and its acute accentuation in the case of life-threatening anemia.

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Uncompensated Blood Loss Is Not Tolerated During Acute Normovolemic Hemodilution in Anesthetized Pigs

Cited by 16 publications

References 22 publications

Perioperative Anämietoleranz

Perioperative Anämietoleranz

Whole Body Periodic Acceleration (pGz) Improves Survival and Allows for Resuscitation in a Model of Severe Hemorrhagic Shock in Pigs

Perioperatives Management bei Zeugen Jehovas

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