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Despite increased use of acute hemodilution (AH) to reduce perioperative blood transfusion in patients undergoing partial hepatectomy, there is a lack of data on safety in those with comorbid medical illness. We performed a retrospective review of 96 patients undergoing partial hepatectomy with AH and low central venous pressure (CVP) anesthesia. The cohort was compared with 63 patients undergoing partial hepatectomy using standard anesthetic management (SA) and low CVP anesthesia. All were American Society of Anesthesiologists physical status 3 or 4. 58 per cent were baseline hypertensive on medication. Hepatic resection was predominantly performed for metastatic colorectal (41%) and primary hepatic (32%) cancer. Forty per cent underwent major hepatectomy. The mean volume of blood removed for AH was 497 mL (range, 0 to 1 L). Most achieved low CVP (AH 90% vs SA 84%, P = 0.3). Blood loss was lower with AH (mean 480 mL vs 904 mL, P< 0.001). Blood transfusion rate was 74 per cent lower with AH (P < 0.001). There was no difference in cardiac, respiratory, renal, or overall complications with AH compared with SA. Acute hemodilution is well tolerated by patients with comorbid illness undergoing partial hepatectomy, favoring ongoing use and further study.
I NTRAOPERATIVE BLOOD LOSS and perioperative transfusion have been identified as potentially modifiable risk factors for 30-day morbidity and mortality across a broad range of surgical procedures. Much focus has been directed at anesthetic techniques to reduce blood loss and subsequent need for blood transfusion. Perioperative methods that have been adopted to decrease the rate of allogeneic blood transfusion include intraoperative cell salvage devices (ICS) and acute hemodilution (AH). ICS is only cost-effective at high volumes of intraoperative blood loss, making it difficult to justify routine use when the degree of blood loss is not entirely predictable.
AH has become increasingly popular as a cost-effective means of decreasing the rate of blood transfusion in healthy adults undergoing a procedure that can be associated with significant hemorrhage.1 Progressive isovolemic anemia, as expected in AH, requires increased tissue perfusion and oxygen extraction to prevent organ dysfunction. The safety in patients with cardiovascular disease is thought to be dependent on degree of anemia and ability to maintain normovolemia.2 Hematocrit less than 25 per cent is associated with increased...