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 21 May 2018

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News

Acute normovolemic hemodilution for major hepatic resection

A study in the latest issue of Annals of Surgery examines acute normovolemic hemodilution vs standard intraoperative management in patients undergoing major hepatic resection.

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Hepatic resection is the most effective treatment for many malignant and benign conditions affecting the liver and biliary tree.

Despite improvements, major partial hepatectomy can be associated with considerable blood loss and transfusion requirements.

Transfusion of allogeneic blood products, although potentially life-saving, is associated with many potential complications.

Dr William Jarnagin  and colleagues determined if acute normovolemic hemodilution, an established blood conservation technique, reduces the requirement for allogeneic red cell transfusions in patients undergoing major hepatic resection.

Overall allogeneic red cell transfusion rate reduced by 50%
Annals of Surgery

The research team prospectively randomized 130 patients undergoing major hepatic resection to undergo either acute normovolemic hemodilution or standard anesthetic management.

In the acute normovolemic hemodilution group, intraoperative blood collection was performed to a target hemoglobin of 8.0 g/dL.

Low central venous pressure anesthetic technique was used intraoperatively for both groups.

A standardized transfusion protocol was applied to all patients intraoperatively and throughout the hospital stay.

From 2004 to 2007, 63 patients were randomized to acute normovolemic hemodilution and 67 to standard anesthetic management.

Demographics, diagnoses, liver function, extent of resection, intraoperative blood loss, operative time, incidence and grade of complications, and length of hospital stay were similar between the 2 groups.

The research team found that acute normovolemic hemodilution reduced the overall allogeneic red cell transfusion rate by 50% compared with standard anesthetic management, respectively.

Acute normovolemic hemodilution patients were less often transfused intraoperatively compared with the standard anesthetic management group, had higher postoperative hemoglobin levels, and tended to require fewer red cell units overall.

In patients with intraoperative blood loss 800 mL or more, acute normovolemic hemodilution reduced not only the allogeneic red cell transfusion rate but also the proportion of patients requiring fresh frozen plasma.

For patients undergoing major liver resection, acute normovolemic hemodilution is safe, effectively reduces the need for allogeneic transfusions, and should be considered for routine use.

Dr Jarnagin's team concludes, "Given the modest transfusion rate in the standard anesthetic management arm, future efforts should attempt to target acute normovolemic hemodilution use to patients most likely to benefit."

Annals of Surgery 2008: 248(3): 360-9
16 September 2008

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