Abstract
To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) in complex spine surgery. Prospective comparative cohort study. A private orthopaedic hospital in Ghana. Seventy-six patients who underwent complex spine deformity surgery. Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution (ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively. Changes in haemodynamic parameters and incidence of allogeneic transfusions and related complications. The mean age (years), gender ratio, deformity size and aetiology, fusion levels, and operative times were similar in both groups. Blood loss (ml) of patients in groups 1 and 2 were 1583ml± 830.48 vs 1623ml ± 681.34, p=0.82, respectively. The rate of allogeneic blood transfusion in groups 1 and 2 were 71% vs 80.65%, p=0.88, respectively. Haemoglobin levels (g/dL) in groups 1 and 2 were comparable in both groups at Post-operative Day (POD) 0 and POD 1. Incidence of minor allogeneic transfusion reaction was 1/45 vs 1/31, p=0.80, group-1 and group-2, respectively. Acute normovolaemic haemodilution can be safely performed in complex spine surgery in underserved regions. However, its use does not obviate allogeneic transfusion in patients with complex spine deformities in whom large volumes of blood loss is expected. None declared.
Highlights
The magnitude and complexity of spine procedures being performed has been increasing worldwide and Ghana is no exception. These major spine surgeries are associated with significant blood loss requiring perioperative blood transfusion, and the volume of allogeneic blood transfused is significantly related to the aetiology and complexity of the surgical procedure and surgical time. 1,2 Allogeneic blood transfusion carries the risks of transmitting infections, haemolytic transfusion reactions, transfusion-related lung injury, and increases hospital costs. 3
A variety of blood conservations techniques are employed in complex spine surgeries including hypotensive anesthesia, antifibrinolytics, intraoperative cell salvage and acute normovolaemic haemodilution (ANH). 6 Acute normovolaemic haemodilution is a blood conservation technique which involves the removal of blood from a patient shortly after induction of anaesthesia, with maintenance of normovolemia using crystalloid and/or colloid replacement.[7,8]
The primary objective of this blood conservation technique is to lower the patient's haemoglobin concentration during surgery so as to minimize the effect of surgical blood loss
Summary
The magnitude and complexity of spine procedures being performed has been increasing worldwide and Ghana is no exception. These major spine surgeries are associated with significant blood loss requiring perioperative blood transfusion, and the volume of allogeneic blood transfused is significantly related to the aetiology and complexity of the surgical procedure and surgical time. A variety of blood conservations techniques are employed in complex spine surgeries including hypotensive anesthesia, antifibrinolytics, intraoperative cell salvage and acute normovolaemic haemodilution (ANH). Acute normovolaemic haemodilution is usually used as a blood conservation technique combined with intraoperative cell salvage, antifibrinolytics (in this case tranexamic acid), and hypotensive anaesthesia
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
