Oxygen Status Parameters as Markers of Renal Dysfunction in Neonatal Infants with Critical Status

Abstract

Objective: to study whether the use of donor blood components can be reduced in patients with baseline anemia during endo-prosthetic replacement of the hip joint. Subjects and methods. The trial was carried out in 262 patients, including 233 patients who had normal preoperative hemoglobin levels and 29 were found to have anemia that was perioperatively corrected using erythropoiesis stimulants (Eprex® (Silag AG, Switzerland)). The patients with normal hemoglobin levels were operated on under normotensive spinal anesthesia (SA) (n=129) and spinal anesthesia with moderate controlled intraoperative hypotension during infusion of microdoses of adrenaline (n=104). All the patients with baseline anemia were operated on under SA with moderate controlled intraoperative hypotension. Results. Preoperative hemopoiesis stimulation in patients with anemia caused a significant increase in hemoglobin and red blood cells in the preoperative period. The volume of intraoperative, drainage, and total blood losses under SA in patients with intraoperative moderate hypotension was significantly lower than that in those with normotensive SA. Throughout the hospitalization, hemotransfusions during erythropoiesis stimulation were needed in 17% of the patients with baseline anemia, in 7% of those with normal preoperative hemoglobin levels, operated on under SA with moderate intraoperative hypotension, and in 40% of those operated on under normotensive SA. Conclusion. The use of erythropoiesis stimulants during preoperative preparation of patients with baseline anemia makes it possible to substantially elevate hemoglobin before surgery and to avoid its considerable postoperative decrease. That of SA with moderate controlled hypotension during endoprosthetic replacement of the hip joint results in the volume of perioperative blood loss, which permits avoidance of packed donor red blood cells in the majority of patients with preoperative anemia during its correction with erythropoiesis stimulants. Key words: endoprosthetic replacement of the hip joint, erythro-poiesis stimulants, spinal anesthesia, blood loss, blood transfusion.