Critical Care Medicine 2003; 31(12):S708-S714
Surgery without blood
Aryeh Shander, MD, FCCM, FCCP
Objective:
The principle aim of "bloodless surgery" is to minimize blood loss and to reduce or eliminate exposure to allogeneic blood transfusion. The risks associated with blood transfusions have been well documented, and it is the goal of bloodless surgery centers to avoid complications and unnecessary use of blood. Blood transfusion is a significant adjunct to perioperative resuscitation. However, we aim to elucidate different approaches to minimizing blood loss and avoiding transfusion.
Design:
In this document, we review the background and current status of bloodless surgery centers and then the different approaches to achieve the program goals.
Findings:
There is no one single universal blood conservation strategy that is applicable to all patients and populations. Factors such as preexisting disease will alter the approach; however, it is the ability of any program to form a comprehensive strategy for blood conservation that is integral to the success of any such program.
Conclusion:
The success of a bloodless surgery program requires both teamwork and careful cooperation between the blood bank, pharmacy, administration, hematologists, surgeon, and anesthesiologist to ensure that the goals of minimizing blood loss and avoiding transfusion are met.
Key Words: bloodless medicine and surgery; preoperative; intraoperative; postoperative; erythropoietin; preoperative autologous donation; antifibrinolytics; cell salvage; acute normovolemic hemodilution
From the Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ.
All requests for reprints should be addressed to: Aryeth Shander, MD, Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital and Medical Center, 350 Engle Street, Englewood, NJ 07631. E-mail:
aryeh.shander@ehmc.com
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