Perioperative blood conservation strategies for major spine surgery. Issue 1 (March 2016)

• Record Type: Journal Article
• Authors: Theusinger, Oliver M.; Spahn, Donat R.
• Is Part Of: Best practice & research. Volume 30:Issue 1(2016)
• Page Start: 41
• Page End: 52
• Publication Date: 2016-03
• Subjects: spine surgery -- goal-directed transfusions -- ROTEM® -- thrombelastometry -- transfusion management -- Patient Blood Management -- spinal deformity surgery; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; Anesthesia -- Periodicals; Anesthetics -- Periodicals; Anesthesia; Anesthesiology; Periodicals; 617.9605
• DOI: 10.1016/j.bpa.2015.11.007
• Languages: English
• ISSNs: 1521-6869

Abstract

Abstract : Background: Orthopedic surgery, especially spine and spinal deformity surgery, may be associated with high perioperative blood loss. In order to reduce the risk of excessive blood loss and unnecessary blood transfusions, strategies such as Patient Blood Management including goal-directed coagulation management have been developed. Recent findings: Adverse effects of allogeneic blood transfusions have been shown for most surgical fields including orthopedic surgery. Several efforts have been made to increase the preoperative red blood cell (RBC) mass, to reduce the intraoperative blood loss, and to use restrictive transfusion triggers in order to minimize or avoid RBC transfusions. Measures to reduce intraoperative blood loss include new surgical techniques, use of cell salvage where possible, bedside coagulation management with point-of-care devices, substitution of coagulation factors, antifibrinolytic agents, and desmopressin, induced hypotension, and avoidance of hypothermia. Summary: Blood conservation in spinal surgery is a multidisciplinary approach and the efficacy of most single measures has been shown. Cost-effectiveness and the benefits of long-term patient outcomes are the subjects of current and future research. Highlights: Increasing the preoperative hemoglobin levels, is a key point regarding the avoidance of blood transfusions. Coagulation management with point-of-care monitoring and coagulation factors reduces the need for blood products. Cost-effectiveness can be achieved with this approach and requires reassessment by all involved parties.