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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2019; 54(05): 516-523
DOI: 10.1016/j.rbo.2018.02.004
Artigo Original | Original Article
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda Rio de Janeiro, Brazil

Acute Normovolemic Hemodilution in Spinal Deformity Surgery[*]

Article in several languages: português | English
Marianna Fergutz Santos Batista 
1   Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
,
Caroline Oliveira Costa
1   Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
,
Emiliano Neves Vialle
1   Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
,
Joana Bretas Rondon Cabral Guasque
1   Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
,
Joana Zulian Fiorentin
1   Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
,
Camila de Santiago Souza
1   Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
› Author Affiliations
Further Information

Publication History

10 December 2017

21 February 2018

Publication Date:
29 October 2019 (online)

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Abstract

Objective To prospectively compare the clinical and laboratorial aspects of patients undergoing spine deformity surgery, using the acute normovolemic hemodilution technique with tranexamic acid, versus a control group with tranexamic acid alone, and to evaluate the influence of hemodilution in intraoperative bleeding and the need for homologous transfusion.

Materials and Methods Comparative prospective study with patients aged between 12 and 65 years undergoing spine deformity surgery with the acute normovolemic hemodilution technique associated with tranexamic acid versus a control group to which only tranexamic acid (15 mg/kg) was administered. Laboratorial exams were performed and analyzed in three different moments.

Results A total of 30 patients were included in the present study: 17 in the hemodilution group, and 13 in the control group. The mean duration of the surgery in the hemodilution group was longer. The number of levels submitted to surgery ranged from 7 to 16 in the hemodilution group, and from 4 to 13 in the control group. Osteotomy, predominantly of the posterior kind, was performed in 20 patients. There was more intraoperative bleeding in the control group. All patients were stable during the procedures. Only 6 participants needed homologous blood transfusion, mostly from the control group (p > 0.05).

Conclusion There was no significant difference between the two groups regarding the need for blood transfusion and intraoperative bleeding. The severity of the deformity was the main determinant for homologous blood transfusion.

Keywords

hemodilution/methods - bleeding - autologous blood transfusion - spine - scoliosis

* Originally Published by Elsevier Editora Ltda.


 

  • Referências

  • 1 Baird EO, McAnany SJ, Lu Y, Overley SC, Qureshi SA. Hemostatic agents in spine surgery: A critical analysis review. JBJS Rev 2015; 3 (01) x
    Google Scholar
  • 2 Maxwell MJ, Wilson MJA. Complications of blood transfusion. BJA Educ 2006; 6 (06) 225-229
    Google Scholar
  • 3 Walunj A, Babb A, Sharpe R. Autologous blood transfusion. BJA Educ 2006; 6 (05) 192-196
    Google Scholar
  • 4 Oriani G, Pavesi M, Oriani A, Bollina I. Acute normovolemic hemodilution. Transfus Apheresis Sci 2011; 45 (03) 269-274
    CrossrefPubMedGoogle Scholar
  • 5 Oppitz PP, Stefani MA. Acute normovolemic hemodilution is safe in neurosurgery. World Neurosurg 2013; 79 (5-6): 719-724
    CrossrefPubMedGoogle Scholar
  • 6 Verma RR, Williamson JB, Dashti H, Patel D, Oxborrow NJ. Homologous blood transfusion is not required in surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Br 2006; 88 (09) 1187-1191
    PubMedGoogle Scholar
  • 7 Kim KT, Park KJ, Lee JH. Osteotomy of the spine to correct the spinal deformity. Asian Spine J 2009; 3 (02) 113-123
    CrossrefPubMedGoogle Scholar
  • 8 Liu H, Yang C, Zheng Z. , et al. Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. Spine 2015; 40 (08) 570-579
    CrossrefPubMedGoogle Scholar
  • 9 Khurana A, Guha A, Saxena N, Pugh S, Ahuja S. Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery. Eur Spine J 2012; 21 (06) 1121-1126
    CrossrefPubMedGoogle Scholar
  • 10 Dhawale AA, Shah SA, Sponseller PD. , et al. Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis?. Spine 2012; 37 (09) E549-E555
    CrossrefPubMedGoogle Scholar
  • 11 Modi HN, Suh S-W, Hong J-Y, Song S-H, Yang J-H. Intraoperative blood loss during different stages of scoliosis surgery: A prospective study. Scoliosis 2010; 5 (01) 16-16
    CrossrefPubMedGoogle Scholar
  • 12 Shapiro F, Sethna N. Blood loss in pediatric spine surgery. Eur Spine J 2004; 13 (Suppl. 01) S6-S17
    CrossrefPubMedGoogle Scholar
  • 13 Bosch P, Kenkre TS, Londino JA, Cassara A, Yang C, Waters JH. Coagulation Profile of Patients with Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion. J Bone Joint Surg Am 2016; 98 (20) e88
    CrossrefPubMedGoogle Scholar
  • 14 El-Dessouky MI, Waly SH, Nasr YM. Acute normovolemic hemodilution in spinal fusion surgery. Egypt J Anaesth 2011; 31: 249-254
    Google Scholar
  • 15 Epstein NE. Bloodless spinal surgery: a review of the normovolemic hemodilution technique. Surg Neurol 2008; 70 (06) 614-618
    CrossrefPubMedGoogle Scholar
  • 16 Stehling L, Zauder HL. Acute normovolemic hemodilution. Transfusion 1991; 31 (09) 857-868
    CrossrefPubMedGoogle Scholar
  • 17 Enercan M, Ozturk C, Kahraman S, Sarıer M, Hamzaoglu A, Alanay A. Osteotomies/spinal column resections in adult deformity. Eur Spine J 2013; 22 (Suppl. 02) S254-S264
    CrossrefPubMedGoogle Scholar
  • 18 Baldus CR, Bridwell KH, Lenke LG, Okubadejo GO. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine 2010; 35 (02) 235-239
    CrossrefPubMedGoogle Scholar
  • 19 Hyun S-J, Rhim S-C. Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients : a long-term follow-up data. J Korean Neurosurg Soc 2010; 47 (02) 95-101
    CrossrefPubMedGoogle Scholar
  • 20 Blanchette CM, Wang PF, Joshi AV, Asmussen M, Saunders W, Kruse P. Cost and utilization of blood transfusion associated with spinal surgeries in the United States. Eur Spine J 2007; 16 (03) 353-363
    CrossrefPubMedGoogle Scholar
  • 21 Tuchman A, Mehta VA, Mack WJ, Acosta Jr FL. Novel application of pre-operative vertebral body embolization to reduce intraoperative blood loss during a three-column spinal osteotomy for non-oncologic spinal deformity. J Clin Neurosci 2015; 22 (04) 765-767
    CrossrefPubMedGoogle Scholar
  • 22 Szpalski M, Gunzburg R, Sztern B. An overview of blood-sparing techniques used in spine surgery during the perioperative period. Eur Spine J 2004; 13 (Suppl. 01) S18-S27
    CrossrefPubMedGoogle Scholar
  • 23 Urban MK, Beckman J, Gordon M, Urquhart B, Boachie-Adjei O. The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine 2001; 26 (10) 1152-1156
    CrossrefPubMedGoogle Scholar
  • 24 Yagi M, Hasegawa J, Nagoshi N. , et al. Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis?. Spine 2012; 37 (21) E1336-E1342
    CrossrefPubMedGoogle Scholar
  • 25 Tayyab NA, Marillier MM, Rivlin M. , et al. Efficacy of aprotinin as a blood conservation technique for adult deformity spinal surgery: a retrospective study. Spine 2008; 33 (16) 1775-1781
    CrossrefPubMedGoogle Scholar
  • 26 Cole JW, Murray DJ, Snider RJ, Bassett GS, Bridwell KH, Lenke LG. Aprotinin reduces blood loss during spinal surgery in children. Spine 2003; 28 (21) 2482-2485
    CrossrefPubMedGoogle Scholar
  • 27 da Rocha VM, de Barros AGC, Naves CD. , et al. Use of tranexamic acid for controlling bleeding in thoracolumbar scoliosis surgery with posterior instrumentation. Rev Bras Ortop 2015; 50 (02) 226-231
    Google Scholar
  • 28 Purvis TE, Goodwin CR, De la Garza-Ramos R. , et al. Effect of liberal blood transfusion on clinical outcomes and cost in spine surgery patients. Spine J 2017; 17 (09) 1255-1263
    CrossrefPubMedGoogle Scholar
  • 29 Fischer ST, Schuroff AA, Vialle LR. Hemodiluição isovolumétrica no tratamento cirúrgico da escoliose idiopática. Rev Bras Ortop 1994; 29 (03) 107-110
    Google Scholar
  • 30 Oliveira GS, Tenório SB, Cumino DO. , et al. Acute normovolemic hemodilution in children submitted to posterior spinal fusion. Rev Bras Anestesiol 2004; 54 (01) 84-90
    Google Scholar
  • 31 Tse EY, Cheung WY, Ng KF, Luk KD. Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am 2011; 93 (13) 1268-1277
    CrossrefPubMedGoogle Scholar