Effects of acute normovolemic hemodilution on allogeneic blood transfusion & coagulation in orthognathic surgery: A randomized study
BACKGROUND Acute normovolemic hemodilution (ANH) is one of the important techniques predominantly used in cardiac, hepatic, and vascular surgery for decreasing allogeneic blood transfusion. However, the effect of ANH in orthognathic surgery has been rarely studied. Therefore, this study aims to assess the ANH-mediated reduction in the allogeneic red blood cell transfusion for orthognathic surgery patients. STUDY DESIGN AND METHODS In this single-center study, 18-80 years old patients were recruited. Patients with hemoglobin ≥11 g/dL and normal coagulation function were randomly divided into ANH or standard treatment group. RESULTS Ninety six patients underwent ANH, and 101 patients received standard treatment. No differences in demographic or major pre-operative characteristics were observed between the two groups. One patient in the ANH and three patients in the standard treatment group received allogeneic blood [3(2.97%) vs. 1(1.16%), control vs. ANH, p = .395]. Multivariate logistic regression analysis revealed that ANH treatment was not associated with transfusion of allogeneic blood (p = .763). After retransfusing autologous blood, PT and APTT in the ANH group significantly increased compared to standard treatment group (PT: -1.73 ± 1.09 vs. -2.15 ± 1.06, p = .035; APTT -6.39 ± 5.76 vs. -8.16 ± 5.70, p = .031; control vs. ANH). No significant differences between the two groups were observed for changes in coagulation parameters at first postoperative day. However, platelet counts in the ANH group decreased compared to the standard group. No significant difference in major adverse outcomes was observed between the two groups. CONCLUSION ANH did not reduce the incidence of allogeneic transfusion in patients undergoing orthognathic surgery.
Autologous blood injection for treatment of chronic recurrent TMJ dislocation: is it successful? Is it safe enough? A systematic review
Oral and Maxillofacial Surgery. 2015;19((3)):243-52.
PURPOSE The purpose of this article is to review the English literature about the efficacy and safety of autologous blood injection in treating patients suffering from chronic recurrent temporomandibular joint dislocation. In this article, we highlight the key trials and recent directions about this modality and discuss about the mechanism, advantages, and disadvantages of this approach. MATERIALS AND METHODS A literature search was performed using PubMed, Medline, and Ovid Medline databases to identify articles reporting on the injection of autologous blood for treatment of chronic recurrent dislocation of temporomandibular joint. Other references cited in the retrieved reports, as well as the "related articles" tool in PubMed Medline, were also checked to improve the search and, if relevant, were included in the study. The search was restricted to articles published in the English language. RESULTS Seven studies meeting the inclusion criteria were reviewed. The selected articles included four prospective clinical trials and three case report articles. CONCLUSION There are a few articles about the clinical use of autologous blood for treating patients with chronic recurrent temporomandibular joint dislocation. Reviewing of the literature shows that there are successful results about this modality, but there are still some concerns about it in terms of the effect of the injected blood on the articular cartilage and formation of fibrous or bony ankylosis.
Evaluation of acute normovolemic hemodilution for surgical repair of craniosynostosis
Journal of Neurosurgical Anesthesiology. 2000;12((1):):33-6.
This clinical report investigated the potential benefit of acute normovolemic hemodilution (ANH) as a blood-saving technique in the surgical repair of craniosynostosis. Over a 4-year period, 34 healthy children undergoing surgical repair of scaphocephaly or pachycephaly were randomly assigned to two groups of 17 patients each. Patients of the first group (ANH group) were submitted to ANH (target Ht: 25%) immediately before surgery and patients of the second group (Control group) were not. During surgery, estimated blood loss was compensated with a 5% albumin solution and no autologous or homologous blood was transfused. At the end of surgery, intraoperative blood loss (mean +/- SD) calculated on the basis of the Ht value and the children weight was 21.3+/-8% of the estimated blood volume (EBV) in the ANH group and 24+/-6.6% in the Control group. Children of the ANH group received their autologous blood (18.9+/-3.3% of EBV) systematically at the end of surgery. In the postoperative period, homologous blood was transfused when the Ht value was equal or less than 21%. Both groups were comparable regarding age, weight, type of craniosynostosis, duration of surgery, EBV, and preoperative Ht value. No difference was observed between ANH and Control groups in the number of patients who received homologous blood (15/17 and 14/17, respectively), in the amount of homologous blood transfused (17+/-4.7% and 19.6+/-6.3% of the EBV, respectively), and in the Ht value before hospital discharge (29.4+/-5.0% and 30.7+/-4.9%, respectively). In conclusion, this report suggests that ANH reduces neither the incidence of homologous transfusion nor the amount of homologous blood transfused in this series of children undergoing surgical repair of craniosynostosis.
Influence of acute normovolaemic haemodilution on the relation between the dose and response of rocuronium bromide
European Journal of Anaesthesiology. 1998;15((1):):21-6.
The influence of acute moderate haemodilution on the relation between dose and response for rocuronium was evaluated in 60 adult patients, ASA grade I, undergoing elective plastic surgery. The patients were randomly allocated to either the control or the haemodilution group. Following the induction of general anaesthesia, the status of acute moderate haemodilution in the haemodilution group was achieved by draining venous blood, and intravenous infusion of lactated Ringer's solution, 6% dextran or gelofusine, during which the levels of haemoatocrit and haemoglobin dropped from 44% to 27.5% and from 148.3 to 91.3 g L-1, respectively. Neuromuscular function was assessed mechanomyographically with train-of-four stimulation at the wrist every 12 s and the percentage depression of T1 response was used as the study parameter. The relation between dose and response for rocuronium in the two groups was determined by the cumulative dose-response technique. The results showed that the dose-response curve for rocuronium during acute moderate haemodilution was shifted in a parallel fashion to the left and the potency of rocuronium was increased. There were significant differences in ED50, ED90 and ED95 between the two groups. The ED50, ED90 and ED95 of rocuronium in the haemodilution group was decreased by 28.2%, 35.4% and 38.8%, respectively, compared with the control group.
Do corticotherapy and hemodilution decrease postoperative inflammation after maxillofacial surgery? . French
Annales Francaises d Anesthesie et de Reanimation. 1996;15((2):):157-61.
OBJECTIVE To assess the efficiency of corticosteroids and preoperative acute normovolaemic haemodilution (PANHD) in reducing postoperative inflammation after maxillofacial surgery. STUDY DESIGN Randomized clinical trial. PATIENTS Thirty-two patients scheduled to undergo maxillary osteotomy for facial dysmorphia were randomized into four groups of eight (PANHD or not; corticosteroids or not). METHODS PANHD decreased haematocrit to 30%. In the corticosteroid groups, methylprednisolone 1.5 mg.kg-1 was given intravenously at the beginning of surgery (after PANHD in haemodiluted group), and after surgery, 1.5 mg.kg-1 iv daily for three days. Postoperative inflammation was assessed with an X-Ray technique (radiotelemetry) providing data on tissue thickness (extent of facial oedema), and by measurement of plasma concentrations of four acute phase proteins during the first postoperative week. RESULTS No change in facial oedema and in acute phase proteins occurred with PANHD. Corticosteroids decreased postoperative oedema and acute phase proteins. CONCLUSION Corticosteroids decrease postoperative inflammation after maxillofacial surgery but not PANHD.
Acute normovolaemic haemodilution does not reduce the inflammatory process induced by facial surgery
Canadian Journal of Anaesthesia. 1995;42((4):):305-9.
The place of preoperative acute normovolaemic haemodilution (haematocrit = 28%-32%) in reducing postoperative inflammation was evaluated after facial surgery. Thirty-two patients scheduled for mandibular osteotomy were randomized to a nonhaemodiluted group or to a haemodiluted group. The degree of postoperative inflammation was evaluated: first by an x-ray technique (radiotelemetry) providing measurements of the tissue thickness (quantitation of facial oedema), and second by the measurement of four acute phase protein plasma concentrations during the first postoperative week. Throughout the study, no changes in facial oedema or in variation of acute phase proteins were detected after haemodilution. It is concluded that acute normovolaemic haemodilution has no effect on the intensity of facial oedema and the biological inflammation process after facial surgery.
Value of hemodilution in maxillofacial surgery for postoperative traumatic edema and graft viability . French
Annales Francaises d Anesthesie et de Reanimation. 1986;5((3):):243-8.
The effects were studied of normovolaemic haemodilution on postoperative traumatic oedema after surgical repair of craniofacial disjunction (CFD) and on pedicle graft viability after excision of squamous carcinomas of the floor of the mouth (CFM). Fourty patients were studied: twenty operated on for CFD and twenty for CFM. These patients were randomly assigned to the treated or the control groups. The treated ones were operated on under moderate normovolaemic haemodilution induced with a colloid solution (Plasmion). The subsequent haematocrits were 0.29 +/- 0.01 for the CFD group and 0.30 +/- 0.02 for the CFM group. The biometric parameters and the length of the surgical procedures were comparable for the two series. Operative blood loss was less in the treated series (p less than 0.001 for the CFD group and p less than 0.01 for the CFM group), thus needing less blood transfusion (p less than 0.001). The postoperative oedema in the treated CFD series was less (p less than 0.001), although the oncotic pressure and the plasma osmolality were decreased in this series (p less than 0.05). On the other hand, viscosity in the hemodiluted series was significantly decreased in comparison with the control series (p less than 0.001). Graft viability was significantly improved in the treated series (p less than 0.05). Thus, normovolaemic haemodilution was a very useful adjunct in plastic and reconstructive surgery of the face and the mouth. This technique had three advantages: reduction of postoperative traumatic oedema after CFM repair, graft viability improvement after mouth carcinoma excision and blood saving in both procedures.