Safety and feasibility of phlebotomy with controlled hypovolemia to minimize blood loss in liver resections
| Autor: | Christopher Wherrett, Fady Balaa, Janelle Rekman, Richard Mimeault, Sean Bennett, Sara Saeed, Kristina Lemon, Guillaume Martel, Mišo Gostimir |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Blood transfusion Colorectal cancer medicine.medical_treatment Hypovolemia Blood Loss Surgical 030230 surgery Cohort Studies 03 medical and health sciences 0302 clinical medicine Phlebotomy medicine Hepatectomy Humans Blood Transfusion Aged Whole blood Aged 80 and over business.industry Liver Neoplasms Central venous pressure Historically Controlled Study Perioperative Middle Aged medicine.disease Surgery 030220 oncology & carcinogenesis Anesthesia Inclusion and exclusion criteria Female medicine.symptom business |
| Zdroj: | Surgery. 161:650-657 |
| ISSN: | 0039-6060 |
| Popis: | Background Liver resection can be associated with significant blood loss and transfusion. Whole blood phlebotomy is an under-reported technique, distinct from acute normovolemic hemodilution, the goal of which is to minimize blood loss in liver operation. This work sought to report on its safety and feasibility and to describe technical considerations. Methods Consecutive patients who had an elective liver resection and concurrent phlebotomy between 2013 and 2016 were examined prospectively. Formal Inclusion and exclusion criteria were defined a priori. All surgical indications were allowed. All procedures were carried out with a stated goal of low central venous pressure anesthesia ( 2 O). The target phlebotomy volume was 7–10 mL/kg of patient body weight. The removed blood was not replaced by intravenous fluid. Removed blood was returned back to the patient after parenchymal transection. Safety end points were examined. A historic cohort (2010–2014) of major resections was included for comparison. Results A total of 37 patients underwent liver resection with phlebotomy (86% major) and 101 without. Half had metastatic colorectal cancer. The median phlebotomy volume was 7.2 mg/kg (4.7–10.2), yielding a median drop in central venous pressure of 3 cm H 2 O (0–15). Median blood loss was 400 vs 700 mL ( P = .0016), and the perioperative transfusion rate was 8.1% vs 32% ( P = .0048). There was no difference between the 2 groups in overall complications, mortality, intensive care admission, duration of stay, or end-organ ischemic complications. Conclusion Whole blood phlebotomy with controlled hypovolemia prior to liver resection seems to be safe and feasible. Comparative studies are required to determine its effectiveness. |
| Databáze: | OpenAIRE |
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