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Anaesthetic strategies to reduce perioperative blood loss in paediatric surgery

Published online by Cambridge University Press:  02 June 2005

T. P. Weber
Affiliation:
University Hospital, Department of Anaesthesiology and Intensive Care, Münster, Germany
M. A. Große Hartlage
Affiliation:
University Hospital, Department of Anaesthesiology and Intensive Care, Münster, Germany
H Van Aken
Affiliation:
University Hospital, Department of Anaesthesiology and Intensive Care, Münster, Germany
M Booke
Affiliation:
University Hospital, Department of Anaesthesiology and Intensive Care, Münster, Germany
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Summary

In adults, a number of measures to reduce perioperative blood loss have been established. These techniques serve to reduce patients' exposure to homologous blood. Most adults are concerned with this issue especially since many patients became infected with human immunodeficiency virus (HIV) during the 1980s through exposure to blood components. While blood-saving strategies are widely used in adults, they are mostly neglected in infants. However, it is these young patients with their whole life in front of them who, it could be argued, would benefit especially from any potentially avoidable infection (HIV, hepatitis, etc.) or immunological complications. In infants and small children, these blood-sparing techniques may not be as effective as in adults and technical limitations may prevent their application. However, some of these measures can be used and may serve to prevent or reduce exposure to homologous blood. In the following review, blood-saving techniques established in adults are described and their applicability for paediatric patients discussed.

Type
Review
Copyright
© 2003 European Society of Anaesthesiology

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References

Booke M, Hinder F, Van Aken H, et al. Methods to reduce postoperative blood loss – Verfahrenstechniken zur Reduktion des postoperativen Blutverlusts. Anesth Intensivmed 1999; 40: 535540.Google Scholar
Forgie MA, Wells PS, Laupacis A, Fergusson D. Preoperative autologous donation decreases allogeneic transfusion but increases exposure to all red blood cell transfusion: results of a meta-analysis. International Study of Perioperative Transfusion (ISPOT) Investigators. Arch Intern Med 1998; 158: 610616.Google Scholar
Mayer MN, de Montalembert M, Audat F, et al. Autologous blood donation for elective surgery in children weighing 8–25 kg. Vox Sang 1996; 70: 224228.Google Scholar
Bryson GL, Laupacis A, Wells GA. Does acute normovolemic hemodilution reduce peroperative allogeneic transfusion? A meta-analysis. The international study of perioperative transfusion. Anesth Analg 1998; 86: 915.Google Scholar
Velardi F, Di Chirico A, Di Rocco C, et al. ‘No allogeneic blood transfusion’ protocol for the surgical correction of craniosynthesis. I. Rationale. Childs Nerv Syst 1998; 14: 722731.Google Scholar
Velardi F, Di Chirico A, Di Rocco C, et al. ‘No allogeneic blood transfusion’ protocol for the surgical correction of craniosynthesis. II. Clinical application. Childs Nerv Syst 1998; 14: 732739.Google Scholar
Kurisu K, Yonenaga K, Miyamoto K, Furusho N, Nishimura K. Open heart surgery without the use of homologous blood in infants and young children: effectiveness of the intraoperative autologous blood donation from arterial monitoring line. Kyobu Geka 1999; 52: 438441.Google Scholar
Huet C, Salmi LR, Fergusson D, Koopman-van Gemert AW, Rubens F, Laupacis A. A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopedic surgery. International study of perioperative transfusion. Anesth Analg 1999; 89: 861869.Google Scholar
Michaelis G, Melzer C, Biscoping J, Hempelmann G. Mechanical autologous transfusion in orthopedic surgery in children. Is the use of mechanical autologous transfusion possible even in pediatric orthopedic surgical procedures? Anaesthesist 1995; 44: 501507.Google Scholar
Mazzarello G, Lampugnani E, Carbone M, Rivabella L, Ivani G. Blood saving in children. Anaesthesia 1998; 53: 3032.Google Scholar
Schwarz U. Intraoperative fluid therapy in infants and young children. Anaesthesist 1999; 48: 4150.Google Scholar
Aly Hassan A, Lochbuehler H, Frey L, Messmer K. Global tissue oxygenation during normovolemic haemodilution in young children. Paediatr Anaesth 1997; 7: 197204.Google Scholar
Booke M, Hagemann O, Van Aken H, et al. Intraoperative autotransfusion in small children: an in vitro investigation to study its feasibility. Anesth Analg 1999; 88: 763765.Google Scholar
Booke M, Van Aken H. What is the minimum weight required to effectively perform intraoperative autotransfusion in small children – an in vitro investigation. Anaesth Intensive Care 2001; 29: 7477.Google Scholar
Friesen RH, Tornabene MA, Coleman SP. Blood conservation during cardiac surgery: ultrafiltration of the extracorporeal circuit volume after cardiopulmonary bypass. Anesth Analg 1993; 77: 702707.Google Scholar
Riou B, Arock M, Guerrero M, et al. Haematological effects of postoperative autotransfusion in spinal surgery. Acta Anaesthesiol Scand 1994; 38: 336341.Google Scholar
Furie B, Furie BC. Molecular and cellular biology of blood coagulation. N Engl J Med 1992; 326: 800806.Google Scholar
Levi M, Cromheecke ME, de Jonge E, et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 1999; 354: 19401947.Google Scholar
Andrew M, Paes B, Johnston M. Development of the hemostatic system in the neonate and young infant. Am J Pediatr Hematol Oncol 1990; 12: 95104.Google Scholar
Ekert H, Gilchrist GS, Stanton R, Hammond D. Hemostasis in cyanotic congenital heart disease. J Pediatr 1970; 76: 221230.Google Scholar
Davies MJ, Allen A, Kort H, et al. Prospective, randomized, double-blind study of high-dose aprotinin in pediatric cardiac operations. Ann Thorac Surg 1997; 63: 497503.Google Scholar
Coniff RF. The Bayer 022 compassionate-use pediatric study. Ann Thorac Surg 1998; 65: S31S33.Google Scholar
Carrel TP, Schwanda M, Vogt PR, Turina MI. Aprotinin in pediatric cardiac operations: a benefit in complex malformations and with high-dose regimen only. Ann Thorac Surg 1998; 66: 153158.Google Scholar
Willimas GD, Bratton SL, Riley EC, Ramamoorthy C. Efficacy of epsilon-aminocaproic acid in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth 1999; 13: 304308.Google Scholar
Reid RW, Zimmerman AA, Laussen PC, Mayer JE, Gorlin JB, Burrows FA. The efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery. Anesth Analg 1997; 84: 990996.Google Scholar
Lethagen S. Desmopressin – a haemostatic drug: state-of-the-art review. Eur J Anaesthesiol 1997; 14 (Suppl 14): 19.Google Scholar
Shiffrin JS, Glass DD. Pro: desmopressin is of value in the treatment of post-cardiopulmonary bypass bleeding. J Cardiothorac Vasc Anesth 1991; 5: 285289.Google Scholar
Salzman EW, Weinstein MJ, Weintraub RM, et al. Treatment with desmopressin acetate to reduce blood loss after cardiac surgery. A double-blind randomized trial. N Engl J Med 1986; 314: 14021406.Google Scholar
Laupacis A, Fergusson D. Drugs to minimize perioperative blood loss in cardiac surgery: meta-analysis using perioperative blood transfusion as the outcome. The international study of perioperative transfusion (ISPOT) investigators. Anesth Analg 1997; 85: 12581267.Google Scholar
Seear MD, Wadsworth LD, Rogers PC, Sheps S, Ashmore PG. The effect of desmopressin acetate (DDAVP) on postoperative blood loss after cardiac operations in children. J Thorac Cardiovasc Surg 1989; 98: 217219.Google Scholar
Reynolds LM, Nicolson SC, Jobes DR, et al. Desmopressin does not decrease bleeding after cardiac operation in young children. J Thorac Cardiovasc Surg 1993; 106: 954958.Google Scholar
Gill JC, Montgomery RR. Failure of response to DDAVP in children less than one year of age. Pediatr Res 1986; 20: 279.Google Scholar
Brecher ME, Taswell HF, Clare DE, Swenke PK, Pineda AA, Moore SB. Minimal-exposure transfusion and the committed donor. Transfusion 1990; 30: 599604.Google Scholar