Clinical Paper
Medicine
Effects of standardized acute normovolemic hemodilution on intraoperative allogeneic blood transfusion in patients undergoing major maxillofacial surgery

https://doi.org/10.1016/j.ijom.2003.10.007Get rights and content

Abstract

The aim of the present study was to demonstrate the practicality and efficacy of acute normovolemic hemodilution (ANH) to reduce allogeneic red blood cell (RBC) transfusion in patients undergoing elective surgery with anticipated high intraoperative blood loss (BL). 124 patients (age 48±18 years, ASA classes I–III) underwent major maxillofacial surgery in a university hospital (68% tumor surgery, 32% dysgnathia correction). After induction of general anesthesia, ANH was performed by standardized withdrawal of 900 ml (2 units) of whole blood and simultaneous infusion of 500 ml of hydroxyethyl starch solution (6% HES 130,000/0.4) and 1500 ml of crystalloidal solution. Intraoperative BL was fluid-compensated until physiologic parameters indicated the need for RBC transfusion. First, autologous ANH-blood was retransfused followed by, if necessary, allogeneic RBC. Total BL was referred to the patient’s calculated blood volume (BV): fractional blood volume loss, BLfract=BL/BV.

ANH took 16±2 min and was void of any adverse event. The costs for ANH was 24€ per patient. 55 patients had a mean BLfract of 44±28% and required an intraoperative transfusion; 49/55 patients with an average BLfract of 37±14% were transfused with only autologous ANH-blood; 6/55 patients with a mean BLfract of 100±47% underwent additional transfusion with allogeneic RBC. Standardized, 2 unit, ANH is a practicable, safe and economic blood conservation technique that allowed for the complete avoidance of allogeneic RBC transfusion in 89% of patients undergoing maxillofacial surgery that required an intraoperative RBC transfusion.

Section snippets

Methods

From March 2001 to May 2002 patients, presenting at the Clinic for Cranio-Maxillofacial Surgery of the Ludwig-Maximilians University Munich and undergoing major elective maxillofacial surgery with anticipated high surgical blood loss were considered candidates for the study.

Exclusion criteria were: (1) preoperative anemia (Hb<10 g/dl) and/or (2) coagulation disorders (Quick<50%, aPTT>50 s, platelet count<100×103/μl, specific deficiencies of coagulation factors). ANH represents a standard

Results

A total of 124 patients who underwent major elective maxillofacial surgery between March 2001 and May 2002 were included into this study. The patient population consisted of: (1) 40 patients who suffered from dentoskeletal dysgnathia and required surgical correction by bimaxillary osteotomies and, (2) 84 patients who had major malignant head and neck tumor infiltrating the maxilla and/or the mandibule thus requiring vast local tumor resection, immediate reconstruction by microvascular

Discussion

The main findings of the present study are: (1) ANH harvesting a fixed volume of 900 ml (2 units) of whole blood in every patient studied was void of adverse events; (2) the standardization of the hemodilution procedure and particularly the omission of targeting a predefined Hb with ANH made this 2 unit ANH a highly practicable and low time-consuming blood conservation strategy; (3) ANH did not delay the start of the operation; (4) in 49/55 (89%) of the patients having met an intraoperative RBC

Acknowledgements

The authors wish to thank Mrs. Christa Haberl and her anesthesia nursing staff as well as Mrs. Angelika Mellen and her surgical nursing staff for their excellent cooperation.

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