Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000200015
Brazilian Journal of Anesthesiology
Review Article

Transfusão sangüínea em crianças e os métodos para evitá-la: uma reavaliação

Blood transfusion in pediatric patients and strategies to decrease it: a reevaluation

Mário José da Conceição

http://dx.doi.org/10.1590/S0034-70942004000200015 Braz J Anesthesiol, vol.54, n2, p.276-282, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: Muitas medidas e técnicas são utilizadas, nos pacientes adultos, na tentativa de reduzir, ou evitar, tanto a perda sangüínea como a administração de sangue homólogo durante atos cirúrgicos para os quais se esperam grandes perdas na volemia. Enquanto as estratégias para evitar a utilização de sangue homólogo em pacientes adultos são largamente empregadas, nos pacientes pediátricos são negligenciadas. Talvez isso se deva ao fato de que em crianças essas técnicas podem não ser tão úteis quanto nos adultos, além dos problemas técnicos próprios do tamanho dos pacientes. O objetivo dessa revisão foi reavaliar as técnicas para reduzir a necessidade de transfusão de sangue homólogo em adultos e discutir sua utilização em pacientes pediátricos. CONTEÚDO: Através da pesquisa bibliográfica apresentam-se às estratégias mais freqüentes para diminuir, ou mesmo evitar, transfusão de sangue homólogo durante atos cirúrgicos nos quais esperam-se grandes perdas volêmicas. Como todos os métodos conhecidos foram desenvolvidos para pacientes adultos, projeta-se, a partir daí, reavaliando-se esses métodos, técnicas e fármacos, uma linha de ação visando a sua aplicabilidade nos pacientes pediátricos. CONCLUSÕES: Mais uma vez fica patente que as soluções obtidas para adultos não são aplicáveis inteiramente aos pacientes pediátricos. As medidas para reduzir o sangramento intra-operatório e a conseqüente redução na necessidade do emprego de sangue homólogo são eficientes em pacientes adultos, porém são de longe mais invasivas, complicadas e muitas delas ineficientes nos pacientes pediátricos, notadamente naqueles abaixo de dois anos de idade.

Palavras-chave

ANESTESIA, DROGAS, SANGUE, SANGUE

Abstract

BACKGROUND AND OBJECTIVES: Several approaches and techniques are used in adult patients to decrease or prevent both blood loss and homologous blood transfusion during surgical procedures where massive blood losses are expected. While these blood-sparing strategies are widely used in adults, they are mostly neglected in children. Perhaps in pediatric patients, these blood-sparing techniques may not be as effective as in adults and technical limitations, as the small size of patients could limit its advantages. In the following review, blood-sparing techniques established for adults are described and their applicability in pediatric patients discussed. CONTENTS: Blood-sparing strategies developed for adult patients aiming at decreasing or even preventing homologous blood transfusion when massive blood losses are expected, are presented through a bibliographic review. Since all known methods were developed for adult patients, an action line was drawn for the reevaluation of these methods, techniques and drugs to be used in pediatric patients. CONCLUSIONS: It has become once more clear that solutions for adult patients may not be as effective for pediatric patients. Intraoperative blood-sparing techniques and consequent decrease in the need for homologous blood are effective for adult patients but are by far more invasive, complicated, and some of them ineffective in pediatric patients, especially those under two years of age.

Keywords

ANESTHESIA, BLOOD, BLOOD, DRUGS

References

Curcio K, Souza MLM. Sangue total e derivados - conceitos e critérios de uso. Rev Bras Anestesiol. 1993;43:(Supl16):1-9.

Macuco MV, Carrenho JMX, Zambonato JF. Efeito imediato da hemodiluição normovolêmica aguda pré-operatória sobre o hematócrito em pacientes adultos. Rev Bras Anestesiol. 1998;48:475-484.

Miyoshi E, Carmona MJC, Uema E. Hemodiluição aguda perioperatória com hidroxietilamido a 6% em cirurgia cardíaca: repercussões hemodinâmicas e sobre o transporte de oxigênio. Rev Bras Anestesiol. 2000;50:26-31.

Forgie MA, Wells PS, Laupacis A. Preoperative autologous donation decreases allogeneic transfusion but increases exposure to all red blood cell transfusion: results of a meta-analysis. International Study of Perioperative Transfusion (ISPOT) Investigators. Arch Intern Med. 1998;158:610-616.

Mayer MN, Montalembert M, Audat F. Autologous blood donation for elective surgery in children weighing 8-25 kg. Vox Sang. 1996;70:224-228.

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

Weiskopf RB. Efficacy of acute normovolemic hemodilution assessed as a function of fraction of blood volume lost. Anesthesiology. 2001;94:439-446.

Huet C, Salmi LR, Fergusson D. A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopedic surgery: International study of perioperative transfusion. Anesth Analg. 1999;89:861-869.

Mazzarello G, Lampugnani E, Carbone M. Blood saving in children. Anaesthesia. 1998;53(^s2):30-32.

Aly Hassan A, Lochbuehler H, Frey L. Global tissue oxygenation during normovolaemic haemodilution in young children. Paediatr Anaesth. 1997;7:197-204.

Booke M, Van Aken H. What is the minimum weight required to effectively perform intraoperative autotransfusion in small children - an in vitro investigation. Anaesth Intensive Care. 2001;29:74-77.

Booke M, Hagemann O, Van Aken H. Intraoperative autotransfusion in small children: an in vitro investigation to study its feasibility. Anesth Analg. 1999;88:763-765.

Friesen RH, Tornabene MA, Coleman SP. Blood conservation during cardiac surgery: ultrafiltration of the extracorporeal circuit volume after cardiopulmonary bypass. Anesth Analg. 1993;77:702-707.

Riou B, Arock M, Guerrero M. Haematological effects of postoperative autotransfusion in spinal surgery. Acta Anaesthesiol Scand. 1994;38:336-341.

American Society of Anesthesiologists Task Force: Practice Guidelines for Blood Component Therapy. Anesthesiology. 1996;84:732-747.

Lethagen S. Desmopressin - a haemostatic drug: state-of-the-art review. Eur J Anaesthesiol. 1997;14(^s14):1-9.

Laupacis A, Fergusson D. Drugs to minimize perioperative blood loss in cardiac surgery: meta-analyses using perioperative blood transfusion as the outcome. The international study of perioperative transfusion investigation. Anesth Analg. 1997;85:1258-1267.

Pereira JCD, Auler Jr JOC. Antifibrinolíticos em cirurgia cardíaca. Estado atual. Rev Bras Anestesiol. 1994;44:205-210.

Levi M, Cromheecke ME, de Jonge E. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevants endpoints. Lancet. 1999;354:1940-1947.

Dalmau A, Sabate A, Acosta F. Tranesaxamic acid reduces red cell transfusion better than epsilon-aminocaproic acid or placebo in liver transplantation. Anesth Analg. 2000;91:29-34.

Reid RW, Burrows FA, Hickey P. Anesthesia for Children Undergoing Heart Surgery. A Practice of Anesthesia for Infants and Children. 2001:391-413.

Andrew M, Paes B, Johnston M. Development of the hemostatic system in the neonate and young infant. Am J Pediatr Hematol Oncol. 1990;12:95-104.

Soilleux H, Gillon MC, Mirand A. Comparative effects of small and large aprotinin doses on bleeding during orthotopic liver transplantation. Anesth Analg. 1995;80:349-352.

Porte RJ, Molenaar IQ, Begliomini B. Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study. Lancet. 2000;355:1303-1309.

Davies MJ, Allen A, Kort H. Prospective, randomised, double-blind study of high-dose aprotinin in pediatric cardiac operations. Ann Thorac Surg. 1997;63:497-503.

Carrel TP, Schwanda M, Vogt PR. Aprotinin in pediatric cardiac operations: a benefit in complex malformations and with high-dose regimen only. Ann Thorac Surg. 1998;66:153-158.

Williams GD, Bratton SL, Riley EC. Efficacy of epsilon-aminocaproic acid in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 1999;13:304-308.

Reid RW, Zimmerman AA, Laussen PC. The efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery. Anesth Analg. 1997;84:990-996.

Grando TA, Puricelli E, Chiao IU. Hipotensão induzida e controlada pelo halotano e nitroprussiato de sódio na cirurgia ortognática. Rev Bras Anestesiol. 1990;40:325-330.

Vieira JL, Katayama M. Hipotensão induzida com bloqueadores alfa e beta1 e halogenados: comparação entre enflurano, halotano e isoflurano em rinoplastias. Rev Bras Anestesiol. 1992;42:201-206.

Grando TA, Puricelli E, Ishiguro RM. Avaliação do risco de complicações em duas técnicas de hipotensão controlada em cirurgi ortognática. Rev Bras Anestesiol. 1996;46:1-7.

Tobias JD, Hersey S, Mencio GA. Nicardipine for controlled hypotension during spinal surgery. J Pediatric Orthop. 1996;16:370-373.

Eckenhoff JE. Deliberate hypotension. Anesthesiology. 1978;48:87-88.

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