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The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery

Pediatric Anesthesia

Submitted December 2023 by Dr Frank Hsiao

Read by 724 Journal Watch subscribers

Take home summary
- This single centre study of 200 paediatric patients undergoing adolescent scoliosis surgery found that an increased volume of intraoperative crystalloid intake is an associated factor with perioperative allogenic blood transfusion
- Further studies are required to investigate a causal relationship

- Significant number of patients undergoing scoliosis surgery still receive allogenic transfusion, despite introduction of measures such as recombinant erythropoietin (rEPO), antifibrinolytic therapy (AFT), and cell-saver
- Optimisation of fluid intraoperative fluid therapy has been shown to decrease perioperative complications in adults
- This study aimed to identify other potential risk factors for perioperative allogenic transfusion

Study overview:
200 paediatric patients in a single centre in France undergoing surgical correction of adolescent idiopathic scoliosis over a 2 year period (2018-2020)
Aimed to investigate the following factors and their association with allogenic transfusions
o body mass index
o preoperative haemoglobin concentration
o thoracoplasty
o preoperative halo-gravity
o volume of intraoperative crystalloid administration
o use of oesophageal Doppler (for goal-directed fluid therapy)
o and duration of surgery

Standardised perioperative management
- Preoperative rEPO and iron supplementation
- Intraoperative TXA, ketamine, dexmedetomidine
- Discretionary use of oesophageal doppler to guide fluid therapy (not mandated)
- Intraoperative dexmedetomidine
- Intraoperative cell saver
- Intrathecal morphine

- 12/200 (6%) patients required allogenic blood transfusion
- Out of the factors considered, normalised intraoperative fluid administration was the strongest associated factor with allogenic transfusion
- The authors postulate that this may be related to haemodilution in the setting of SIADH and fluid retention, although no causative relation can be made
- There was not a statistically significant difference in intraoperative cell saver blood transfusion to suggest a difference in intraoperative blood loss
- The authors advised caution in generalising the result in the context of a small, monocentric study

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