British Journal of Anaesthesia, Vol 79, Issue 3 317-321, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
D. Olsfanger, B. Fredman, B. Goldstein, A. Shapiro and R. Jedeikin
We hypothesized that the success of postoperative blood conservation after
acute normovolaemic haemodilution (NVHD) is influenced by the extent of
intraoperative bleeding and surgical trauma, and the timing of autologous
blood transfusion. As total knee replacement is associated with minimal
intraoperative but extensive postoperative blood loss, this procedure is
ideally suited to acute NVHD. Therefore, to test our hypothesis, 30
patients undergoing elective total knee replacement were enrolled in a
prospective, randomized, controlled study. In groups NVHD-2 and NVHD-6,
before induction of anaesthesia patients were bled to a target packed cell
volume (PCV) of 28-30%, and in the post-anaesthesia care unit autologous
blood was transfused over a 2-h period terminating after operation at 2 and
6 h, respectively. In the control group, NVHD was not performed. After
operation, platelets, fibrinogen, prothrombin and partial thromboplastin
time, and liver function, urea and electrolytes were measured and compared
with preoperative baseline values. Significantly (P < 0.024) more
allogeneic blood was transfused in the control group (21 u.) compared with
either group NVHD-2 (7 u.) or group NVHD-6 (5 u.). In the control group,
despite the allogeneic blood transfusion, postoperative PCV decreased until
day 4 after operation. Coagulation profile, liver function and urea and
electrolytes concentrations were unaffected by the method of treatment. We
conclude that for total knee replacement, acute NVHD is an effective blood
conservation strategy. However, there was no difference in allogeneic blood
administration between the two NVHD groups. Coagulation and liver function,
and urea and electrolyte concentrations were unaffected by treatment.
CLINICAL INVESTIGATIONS
Acute normovolaemic haemodilution decreases postoperative allogeneic blood transfusion after total knee replacement
Department of Anesthesiology and Critical Care, Meir Hospital, Kfar Sava, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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