Strategy of perioperative volume therapy in patients undergoing spinal surgery: thromboelastography versus massive transfusion protocol

Abstract

Objective To compare the efficacy of perioperative volume therapy guided by thromboelastography(TEG)versus massive transfusion protocol(MTP)in patients undergoing spinal surgery. Methods Seventy-two American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 14-64 yr, weighing 42-89 kg, undergoing elective scoliosis correction surgery or lumbar spinal stenosis decompression, were divided into TEG group(group T, n=36)and MTP group(group M, n=36)using a random number table.Fresh frozen plasma(FFP), platelet(PLT)and fibrinogen(FIB)were transfused or protamine and tranexamic acid were given according to the results of TEG in group T. In group M, FFP and PLT were transfused after allogeneic RBCs or autologous blood were transfused according to the ratio allogeneic red blood cells(RBCs)1 U(or autologous blood 200 ml): FFP 100 ml: PLT 1 U; when ACT>110% of baseline, protamine was given; tranexamic acid was given according to the experience of anesthesiologists.Venous blood samples were collected before induction of anesthesia(T0), at the end of surgery(T1)and at 24 h after operation(T2)for measurement of hemoglobin and blood coagulation.Blood loss, volume of fluid infused, transfusion of allogeneic blood(RBC, FFP and PLT), FIB, and consumption of protamine and tranexamic acid during the perioperative period, intraoperative volume of autologous blood transfused and time for initial infusion of FFP and PLT were recorded.The development of re-operation due to massive bleeding within 24 h after operation and death was recorded.The allogeneic blood transfusion cost, TEG detection cost, comprehensive cost(sum of allogeneic blood transfusion cost and TEG detection cost)and length of hospital stay were also recorded. Results Compared with group M, PLT count and FIB concentration were significantly decreased at T1, the perioperative consumption of FFP and PLT was reduced during the perioperative period, the time for initial infusion of FFP and PLT was prolonged, the allogeneic blood transfusion cost was decreased, the comprehensive cost was increased(P 0.05). Conclusion TEG produces better efficacy in guiding perioperative volume therapy than MTP in the patients undergoing spinal surgery. Key words: Fluid therapy; Thromboelastography; Blood transfusion