Safety Of Acute Normovolemic Hemodilution Research Articles

Acute normovolemic hemodilution in combination with tranexamic acid is an effective strategy for blood management in lumbar spinal fusion surgery

BackgroundThe retrospective study was designed to compare the effectiveness and safety of acute normovolemic hemodilution (ANH), tranexamic Acid (TXA), and a combination of ANH and TXA in lumbar spinal fusion surgery.MethodsData of 120 patients underwent multi-level posterior spinal fusion for treating degenerative lumbar disease between June 2013 and December 2017 was collected, retrospectively. Four treatment strategies were enrolled, including ANH, TXA, a combination of ANH and TXA, and without any patient blood management. Intraoperative blood loss, hemoglobin and PCV at the end of surgery and at the postoperative first day, and postoperative drain collection, and intraoperative and postoperative transfusion and rate of transfusion were also collected.ResultsIntraoperative blood loss and postoperative drain collection of the TXA group, ANH combined with TXA group were statistically lower than those in the control group and ANH group (P < 0.05). Intraoperative and postoperative transfusion amount and rate of intra-operative allogenic transfusion of the ANH group, TXA group, and ANH combined with TXA group were statistically lower than those of the control group (P < 0.05). Hemoglobin and PCV at postoperative the first day in the ANH group, TXA group, and ANH combined with TXA group were significant higher than those in the control group (P < 0.05). The combination of TXA and ANH group achieved the lowest intraoperative blood loss, postoperative drain collection and allogenic transfusion rate.ConclusionA combination of TXA and ANH might be an effective strategy for reducing the rate of transfusion and blood loss in patients underwent lumbar spinal fusion surgery.

Evaluation of acute normovolemic hemodilution in patients undergoing intracranial meningioma resection: A quasi-experimental trial.

The aim of this study was to evaluate the safety of acute normovolemic hemodilution (ANH) for patients undergoing intracranial meningioma resection.Eighty patients (aged 48–65 years) with American Society of Anesthesiologists physical status I–II undergoing intracranial meningioma resection were included in this prospective observational study. The patients were randomly divided into group A (ANH group), which underwent a combination of ANH and intraoperative cell salvage (ICS), and group B (control group), which underwent ICS alone. The study parameters were recorded as baseline values before blood drainage (T0), after blood drainage (T1), and before (T2) and after (T3) retransfusion in group A. Whereas in group B, the same parameters were measured 10 minutes after anesthesia induction (T0), before surgery (T1), and before (T2) and after (T3) transfusion of autologous blood.When intraoperative blood loss was <2000 mL, the mean volume of homologous blood transfused in group A patients was 100.8 ± 82.3 mL, compared with the 190.0 ± 91.8 mL in group B. Reduction in homologous blood used in group A was statistically significant (P < .05). In group B, 15.1% patients received homologous blood, whereas only 5.9% patients received homologous blood in group A. The difference in heart rate between both groups at different time points was statistically nonsignificant (P > .05). The mean hemoglobin and hematocrit levels at T1 and T2 in group A were lower than in group B (P < .05). The prothrombin time and activated partial thromboplastin time in both groups were prolonged significantly after T2 (all P < .05), but were all within normal range. There were no significant differences in postoperative hospital stay, mortality, and postoperative infection between the 2 groups.For patients undergoing excision of intracranial meningioma, ANH is an effective procedure to reduce the need for allogeneic transfusions.

Effects of acute normovolemic hemodilution on plasma homeostasis during one-lung ventilation

Objective To investigate the effects of acute normovolemic hemodilution (ANHD) on plasma homeostasis during one-lung ventilation (OLV), and the safety of ANHD. Methods Forty ASA I or II patients undergoing elective thoracic surgery under OLV were randomly assigned to receive ANHD with Hct of 30% (study group) or no hemodilution (control group). ECG, BP, CVP, SaO2, and cardiac output (CO) were monitored intraoperatively. Blood gases and lactic acid levels were determined before ANHD (T1), 30 rain after ANHD (T2), 15 min after OLV (T3), and 30 min after OLV (T4); so was cardiac index. Results Values of PH and BE and levels of Na+, K+, Ca2+ and lactic acid in the two groups did not differ significantly at different time point. CO increased by 27.3% after ANHD and continued to elevate after OLV, showing a statistical difference between the two groups at different time points (P<0.05); while there were no significant differences in the other hemodynamic indicators. Conclusiona Acute normovolemic hemodilution during one-lung ventilation is safe and feasible and can maintain hemodynamics and homeostasis. Key words: Acute normovolemic hemodilution; One-lung ventilation; Homeostasis

Use of acute normovolemic hemodilution in patients undergoing radical prostatectomy

Objectives To evaluate the efficacy and safety of acute normovolemic hemodilution (ANH) in patients undergoing radical prostatectomy. Preoperative autologous blood donation (PAD) is widely accepted as a means of reducing the need for allogeneic blood transfusion in radical prostatectomy. ANH is an alternative method for obtaining autologous blood. Methods On the basis of our previous report that showed the equivalence of PAD and ANH, we prospectively replaced PAD with ANH as a standard practice for radical prostatectomy after September 1999. Of 174 radical prostatectomy patients between September 1999 and June 2004, 153 underwent ANH alone, 15 chose to receive both PAD and ANH, and ANH was contraindicated in 15 because of comorbidities. Results For the 153 patients undergoing ANH alone, 1032 ± 201 mL of autologous blood was collected. With an intraoperative blood loss of 1602 ± 926 mL, 14 patients (9.2%) received allogeneic blood transfusion. The preoperative, intraoperative nadir, and postoperative hematocrit value was 43.6% ± 3.4%, 25.8% ± 3.8%, and 31.9% ± 4.3%, respectively. No patient experienced a perioperative adverse event related to hemodilution or blood transfusion. Conclusions Our continued experience has shown that ANH is a safe and effective means of autologous blood procurement. Given its advantages, including lower cost, lower risk, and simplicity, we conclude that ANH can replace conventional PAD for use in radical prostatectomy, although the true value of ANH should be determined by future randomized studies including a no-treatment control group.