Hemodiluição normovolêmica aguda em crianças submetidas a artrodese de coluna vertebral pela via posterior

Gizelda S de Oliveira; Sérgio Bernardo Tenório; Débora O Cumino; Daniela B Garcia Gomes; Edson N Namba; José Luis A Maidana; Luiz Eduardo Munhoz da Rocha

doi:10.1590/S0034-70942004000100012

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Hemodiluição normovolêmica aguda em crianças submetidas a artrodese de coluna vertebral pela via posterior

Acute normovolemic hemodilution in children submitted to posterior spinal fusion

Gizelda S de Oliveira; Sérgio Bernardo Tenório; Débora O Cumino; Daniela B Garcia Gomes; Edson N Namba; José Luis A Maidana; Luiz Eduardo Munhoz da Rocha

http://dx.doi.org/10.1590/S0034-70942004000100012 Braz J Anesthesiol, vol.54, n1, p.84-90, 2004

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JUSTIFICATIVA E OBJETIVOS: A hemodiluição normovolêmica aguda (HNA) é um método de transfusão autóloga simples e de baixo custo. O objetivo deste estudo foi verificar se a HNA pode reduzir a necessidade de sangue homólogo em crianças submetidas à artrodese da coluna vertebral pela via posterior e avaliar as complicações decorrentes da hemodiluição nesse tipo de paciente. MÉTODO: Participaram do estudo 25 crianças, estado físico ASA I e II, submetidas a artrodese de coluna pela via posterior, e que receberam HNA (grupo H). Foram registrados os valores do hematócrito no início e fim da cirurgia, na alta da terapia intensiva e do hospital, o percentual de crianças que recebeu transfusão homóloga durante e após a cirurgia e as complicações ocorridas no intra e no pós-operatório. Os dados do grupo H foram comparados com outro grupo de crianças submetidas ao mesmo tipo de cirurgia, mesma técnica anestésica, porém sem HNA (grupo S). RESULTADOS: As medianas de idade e peso dos dois grupos H e S foram respectivamente 13 e 12 anos e 41,5 e 34 kg. Foram retirados 523 ml de sangue do grupo H, no início da cirurgia, equivalente a 17,1% da volemia, e reinfundida simultaneamente solução de Ringer com lactato, reduzindo o hematócrito para 28,8% ± 3.72%. No final da cirurgia, após a reinfusão do sangue autólogo, hematócrito atingiu o valor médio de 27% no grupo H e 30,4% no grupo S (p = 0,01). Na alta da unidade de terapia intensiva e na alta do hospital, as diferenças entre os hematócritos não eram estatisticamente significativas. Transfusão de sangue homólogo foi utilizada em 28% das crianças do grupo H e 79% do grupo S (p = 0,001). Hipotensão arterial ocorreu em 28% dos pacientes do grupo H e 37,5% do grupo S (p = 0,9). No grupo S, 4 pacientes tiveram complicações infecciosas importantes no pós-operatório. A duração da internação hospitalar nos grupos H e S foram, respectivamente, 7,56 ± 3,203 dias e 9,75 ± 4,245 dias (p = 0,009). O grupo H recebeu 3.948 ± 1.334 ml de Ringer com lactado e o grupo controle 2.234 ± 953 ml (p < 0,0001). CONCLUSÕES: A hemodiluição normovolêmica aguda é um método seguro e capaz de reduzir a necessidade por sangue homólogo em crianças submetidas à artrodese de coluna. Não houve complicações decorrentes da anemia.

Palavras-chave

ANESTESIA, Pediátrica, CIRURGIA, Ortopédica, SANGUE

Abstract

BACKGROUND AND OBJECTIVES: Acute Normovolemic Hemodilution (ANH) is a simple and low-cost autologous transfusion method. This study aimed at evaluating whether ANH is able to decrease homologous transfusions in children undergoing posterior spinal fusion and at verifying hemodilution-induced complications in those patients.
METHODS: Participated in this study 25 children, physical status ASA I and II, submitted to posterior spinal fusion and receiving ANH (group H). Hematocrit values were recorded at surgery beginning and completion, at PACU and hospital discharge. The number of children receiving homologous transfusions during and after surgery, as well as intra and postoperative complications were also recorded. Group H data were compared to other group of children submitted to the same surgical technique, however without ANH (group S).
RESULTS: Median age and weight for both groups were, respectivelly 13 and 12 years and 41.5 and 34 kg. Immediately after anesthetic induction, 523 ml (mean) of blood were collected from group H, or the equivalent to 17.1% of volemia. Simultaneously, lactated Ringer's solution was started to decrease hematocrit to 28.8% ± 3.72%. At surgery completion and after autologous blood infusion, hematocrit has reached mean values of 27% in group H and 30.4% in Group S (p = 0.01). At PACU and hospital discharge, differences between hematocrits were not statistically significant. Homologous blood was transfused in 28% of Group H children and 79% of Group S children (p = 0.001). There has been arterial hypotension in 28% of Group H patients and 37.5% of Group S patients (p = 0.9). Four Group S patients had severe postoperative infectious complications. Hospital stay for Groups H and S was, respectively 7.56 ± 3.203 days for group H, and 9.75 ± 4.245 days for group S (p = 0.009). Group H has received 3.948 ± 1.334 ml lactated Ringer's and group S has received 2.234 ± 953 (p = 0.0001).
CONCLUSIONS: Normovolemic hemodilution is a safe method to decrease homologous blood needs in children submitted to posterior spinal fusion. There have been no anemia-related complications.

Keywords

ANESTHESIA, Pediatric; BLOOD: normovolemic hemodilution; SURGERY, Orthopedic

References

Dodd RY. The risk of transfusion-transmitted Infection. N Engl J Med. 1992;327:419-420.

Spahn D, Casutt M. Eliminating blood transfusions. Anesthesiology. 2000;93:242-255.

Triulzi DJ, Vanek K, Ryan DH. A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion. 1992;32:517-524.

Avall A, Hyllner M, Bengtson JP. A postoperative inflammatory response after autologous and allogenic blood transfusion. Anesthesiology. 1997;87:511-516.

Crosby ET. Perioperative haemotherapy: II. Risks and complications of blood transfusion. Can J Anaesth. 1992;39:822-837.

Wolf CFW, Canale VC. Fatal pulmonary hypersensitivity reaction to HL-A incompatible blood: Transfusion: report of a case and review of the literature. Transfusion. 1976:135-140.

Myhre BA. Fatalities from blood transfusions. JAMA. 1980;244:1333-1335.

Spiess BD, Counts RB, Gould AS. A History of Transfusion. Perioperative Transfusion Medicine. 1998:9-10.

Goodnough LT, Brecher ME, Kanter MH. Transfusion Medicine, Part I. N Engl J Med. 1999;340:438-444.

Bryson GL, Laupacis A, Wellls GA. Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion?: A meta-analysis. Anesth Analg. 1998;86:9-15.

Loubser PG, De Juan R. Survey of acute normovolemic hemodilution utilization by Anesthesiology programs. Anesthesiology. 1998:A-1193.

Ereth MH, Oliver Jr W, Santrach PJ. Intraoperative Techniques to Conserve Autologous Blood: Red-Cell Salvage, Platelet-Rich Plasma, and Acute Normovolemic Hemodilution. Perioperative Transfusion Medicine. 1998:336-342.

Gillon J, Thomas MJG, Desmond MJ. Acute normovolaemic haemodilution. Transfusion. 1996;36:640-643.

Stehling L, Zauder HL. Controversies in transfusion Medicine - Perioperative hemodilution: Pro. Transfusion. 1998;34:265-268.

Guay J, Haig M, Lortie L. Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth. 1994;41:775-781.

Du Toit, Relton JES, Gillespie R. Acute hemodilutional autotransfusion in the surgical management of scoliosis. J Bone Joint Surg. 1978;60:178-180.

Schaller RT, Schaller J, Morgan A. Hemodilution anesthesia: a valuable aid to major cancer surgery in children. Am J Surg. 1983;146:79-84.

Kraft M, Dedrick D, Goudsouzian N. Hemodilution in an eight-month infant. Anaesthesia. 1981;36:402-404.

Goodnough LT, Brecher ME, Kanter MH. Transfusion Medicine, Part II. N Engl J Med. 1999;340:525-533.

Feldman JM, Roth JV, Bjoraker DG. Maximum blood sabing by acute normovolemic hemodilution. Anesth Analg. 1995;80:108-113.

Robertie PG, Gravlee TP. Safe limits of isovolemic hemodilution and recommendations for erythrocyte transfusion. Intern Anesth Clin. 1990;28:197-204.

Tambara EM. Avaliação da Hemodiluição Normovolêmica: Estudo Experimental em Cães. .

Laks H, Pilon RN, Klovekorn Anderson W. Acute hemodilution: its effect on hemodynamics and oxygen transport in anesthetized man. Ann Surg. 1974;180:103-109.

Bruder N, Cohen B, Pellissier D et al. The effect of hemodilution on cerebral blood flow velocity in anesthetized patients. Anesth Analg. 1998;86:320-324.

Iterson MV, Waart FJMV, Erdmann W. Systemic haemodynamics and oxygenation during haemodilution in children. Lancet. 1995;346:1127-1129.

Ford CD, Van Moorleghem G, Menlove R. Blood transfusions and postoperative wound infection. Surgery. 1993;113:603-607.

Agarwal N, Murph JG, Cayten CG. Blood transfusion increases the risk of infection after trauma. Arch Surg. 1993;128:171-176.

Mezrow CK, Bergstein I, Tartter PI. Postoperative infections following autologous and homologous blood transfusions. Transfusion. 1992;32:27-30.

Landers DF, Hill GE, Wong KC. Blood transfusion-induced immunomodulation. Anesth Analg. 1996;82:187-204.

Hemodiluição normovolêmica aguda em crianças submetidas a artrodese de coluna vertebral pela via posterior

Acute normovolemic hemodilution in children submitted to posterior spinal fusion

Gizelda S de Oliveira; Sérgio Bernardo Tenório; Débora O Cumino; Daniela B Garcia Gomes; Edson N Namba; José Luis A Maidana; Luiz Eduardo Munhoz da Rocha

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