Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942005000100009
Brazilian Journal of Anesthesiology
Scientific Article

Alterações pós-anestésicas do hematócrito em cirurgias ortognáticas

Postanesthetic hematocrit changes in orthognathic surgery

Tailur Alberto Grando; Edela Puricelli; Airton Bagatini; Cláudio Roberto Gomes; Carolina Guerra Baião; Deise Ponzoni

http://dx.doi.org/10.1590/S0034-70942005000100009 Braz J Anesthesiol, vol.55, n1, p.78-86, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: Com o aumento de doenças transmissíveis através das transfusões sangüíneas, as suas indicações estão sendo muito questionadas. Os objetivos deste trabalho são avaliar a perda sangüínea peri-operatória, e a recuperação do hematócrito após 14 dias, em pacientes submetidos à cirurgia ortognática, realizada sob anestesia geral e hipotensão controlada, com três diferentes técnicas de reposição volêmica. MÉTODO: Foi realizado um estudo prospectivo em pacientes submetidos consecutivamente à cirurgia ortognática, no período entre agosto de 1985 a julho de 2003. Os pacientes foram divididos em três grupos; grupo I, com autodoação prévia de 7 dias; grupo II, com autodoação intra-operatória; e grupo III, com hemodiluição normovolêmica. A medicação pré-anestésica, a indução, a manutenção, os fármacos e a monitorização foram padronizados. Os pacientes foram submetidos à anestesia geral com hipotensão arterial induzida e controlada. Foram analisados a perda sangüínea, o tempo anestésico, as pressões sistólica, diastólica e média, a freqüência cardíaca, o hematócrito e a hemoglobina antes da indução anestésica, e o hematócrito e a hemoglobina após 60 horas e 14 dias do pós-operatório bem como as complicações peri-operatórias. RESULTADOS: A perda sangüínea foi de 1340,03 ± 427,97 no grupo I; 1098,08 ± 429,30 no grupo II; e 1044,71 ± 526,56 no grupo III, com diferença estatística significativa no grupo I em relação aos grupos II e III. Houve diminuição significativa do hematócrito antes da indução da anestesia (24%), comparado aos resultados obtidos em 60 horas, e restauração de 83% do hematócrito, em 14 dias. CONCLUSÕES: A perda sangüínea peri-operatória nos três grupos foi considerável, com mínima necessidade de transfusão de sangue alogênico. A quase totalidade dos pacientes tolerou a perda sangüínea, pois eram em geral jovens, estado físico ASA I e II e sem grande comorbidade associada. O hematócrito em 14 dias não recuperou o valor pré-operatório.

Palavras-chave

CIRURGIA, TÉCNICAS ANESTÉSICAS, Geral, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Blood transfusions have been heavily questioned due to the increased number of transfusion-transmitted diseases This study aimed at evaluating perioperative blood loss and hematocrit recovery in 14 days, in patients submitted to orthognathic surgery under induced hypotensive anesthesia, with three different volume replacement techniques. METHODS: This was a prospective study of consecutive patients submitted to orthognathic surgery in the period August 1985 to July 2003. Patients were distributed in three groups: group I with pre-operative self-donation of blood 7 days before surgery; group II with intraoperative self-donation; and group III with normovolemic hemodilution. Pre-medication, induction, maintenance, drugs and monitoring were standardized. Patients were submitted to induced hypotensive general anesthesia. The following data were evaluated: blood loss, anesthetic length, systolic, diastolic and mean blood pressure, heart rate, hematocrit and hemoglobin at pre-induction, 60 hours after the first sample and at 14th the postoperative day, as well as perioperative complications. RESULTS: Blood loss was 1340.03 ± 427.97 in group I; 1098.08 ± 429.30 in group II; and 1044.71 ± 526.56 in group III, with statistical significance in group I as compared to groups II and III. There was significant decrease in pre-induction hemoglobin as compared to 60 hours and 83% hematocrit recovery in 14 days. CONCLUSIONS: Perioperative blood loss for all groups was high, with need for allogeneic blood transfusion. Virtually all patients have tolerated blood loss since in general they were young patients, physical status ASA I and II without associated diseases. Hematocrit has not returned to preoperative values after 14 days.

Keywords

ANESTHETIC TECHNIQUES, General, MEASUREMENT TECHNIQUES, SURGERY

References

Purdy FR, Tweeddale MG, Merrick PM. Association of mortality with age of blood transfused in septic ICU patients. Can J Anaesth. 1997;44:1256-1261.

Miller RD. Update on blood transfusion and blood substitutes. IARS Review Course Lectures. 1999:71-78.

Messmer KF. Acceptable hematocrit levels in surgical patients. World J Surg. 1987;11:41-46.

Thomas MJ, Desmond MJ, Gillon J. General background paper: Consensus Conference on Autologous Transfusion. Transfusion. 1996;36:628-632.

Lee SJ, Liljas B, Churchill WH. Perceptions and preferences of autologous blood donors. Transfusion. 1998;38:757-763.

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

McKinlay S, Gan TJ. Intraoperative fluid management and choice of fluids. 2003:127-137.

Thomas MJ, Desmond MJ, Gillon J. General background paper: Consensus Conference on Autologous Transfusion. Transfusion. 1996;36:628-632.

Goodnough LT, Monk TG, Brecher ME. Acute normovolemic hemodilution should replace the preoperative donation of autologous blood as a method of autologous-blood procurement. Transfusion. 1998;38:473-476.

Spahn DR, Zollinger A, Schlumpf RB. Hemodilution tolerance in elderly patients without known cardiac disease. Anesth Analg. 1996;82:681-686.

Martineau RJ. Pro: a hematocrit of 20% is adequate to wean a patient from cardiopulmonary bypass. J Cardiothororac Vasc Anesth. 1996;10:291-293.

Gandini G, Franchini M, Bertuzzo D. Preoperative autologous blood donation by 1073 elderly patients undergoing elective surgery: a safe effective practice. Transfusion. 1999;39:174-178.

Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58:277-280.

Rottman G, Ness PM. Acute normovolemic hemodilution is a legitimate alternative to allogeneic blood transfusion. Transfusion. 1998;38:477-480.

Welch HG, Meehan KR, Goodnough LT. Prudent strategies for elective red blood cell. Ann Intern Med. 1992;116:393-402.

Ness PM, Bourke DL, Walsh PC. A randomized trial of perioperative hemodilution versus transfusion of preoperative deposited autologous blood in elective surgery. Transfusion. 1992;32:226-230.

Grando TA, Puricelli E, Ishiguro RM. Avaliação da perda sangüínea em cirurgia ortognática usando técnicas de autotransfusão e hemodiluição. Rev Bras Anestesiol. 1994;44(^s18):CBA067.

Grando TA, Puricelli E. Anestesia em Cirurgia Bucomaxilofacial e Trauma Bucomaxilofacial no Manejo da Via Aérea. Anestesiologia Princípios e Técnicas. 1997:630-639.

Leone BJ. Hemodilution: an alternative to transfusion. . :45-47.

Samman N, Cheung LK, Tong AC. Blood loss and transfusions requirements in orthognathic surgery. J Oral Maxillofac Surg. 1996;54:21-24.

Precious DS, Splinter W, Bosco D. Induced hypotensive anesthesia for adolescent orthognathic surgery patients. J Oral Maxillofac Surg. 1996;54:680-683.

Puelacher W, Hinteregger G, Nussbaumer W. Preoperative autologous blood donation in orthognathic surgery: a follow-up study of 179 patients. J Craniomaxillofac Surg. 1998;26:121-125.

Hillman RS. Acute Blood Loss Anemia. Principles of Transfusion Medicine. 1995:704-708.

Cecil B. Essentials of Medicine. 1986:334-336.

Stoelting RK. Pharmacology and Phisiology in Anesthetic Practice. 1995:801-803.

Technical Manual: American Association of Blood Banks. 1996:109-114, 413-445.

Goodnough LT, Brecher ME, Kanter MH. Transfusion medicine: Second of two part - blood conservation. N Engl Med. 1999;340:525-533.

Kasper SM, Gerlich W, Buzello W. Preoperative red cell production in patients undergoing weekly autologous blood donation. Transfusion. 1997;37:1058-1062.

Pree C, Mermillod B, Hoffmeyer P. Recombinant human erythropoietin as adjuvant treatment for autologous blood donation in elective surgery with large blood needs: a randomized study. Transfusion. 1997;37:708-714.

Nielsen VG, Baird MS, Brix AE. Extreme progressive isovolemic hemodilution with 5% human albumin, Pentalyte, or Hextend does not cause hepatic ischemia or histologic injury in rabbits. Anesthesiology. 1999;90:1428-1435.

Rosencher N, Kerkkamp HE, Macheras G. Orthopedic surgery transfusion hemoglobin European overview study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003;43:459-469.

Hay SN, Monk TG, Brecher ME. Intraoperative blood salvage: a mathematic perspective. Transfusion. 2003;42:451-455.

Berenholtz SM, Pronovost PJ, Mullany D. Predictors of transfusion for spinal surgery in Mariland, 1997 to 2000. Transfusion. 2002;42:183-189.

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