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
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
Background: - 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
Results: - 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
