[Risks and side effects of intraoperative autotransfusion]

Area of Science:

• Anesthesiology and Perioperative Medicine
• Transfusion Medicine
• Surgical Patient Management

Context:

• Autotransfusion has been standard practice for orthopedic and surgical patients at the University of Würzburg since the 1970s.
• Current methods utilize the Haemonetics-Cell-Saver 3 for preparing autologous erythrocyte concentrates.
• Older autotransfusion devices pose risks, primarily venous air embolism during manual operation.

Purpose:

• To outline critical safety measures for autotransfusion procedures to mitigate potential hazards.
• To emphasize the importance of managing coagulation parameters during extensive blood replacement.
• To address the risks of air embolism and blood contamination associated with cell salvage.

Summary:

• Venous air embolism is a significant risk during manual autotransfusion; clamping the connecting tube to the patient during filling and between the centrifuge and retransfusion bag is crucial.
• Extensive autotransfusion necessitates monitoring hemostaseological parameters (e.g., Quick, thrombin time, antithrombin III) after replacing half the estimated blood volume to manage coagulation disorders.
• Substitution of antithrombin III is often required to reduce risks of venous thrombosis and pulmonary embolism.
• Potential blood contamination from operating room suction requires minimizing personnel and optimizing suction device function.
• Implementing these safety protocols minimizes the risks associated with this effective blood-saving procedure.

Impact:

• Enhances patient safety during autotransfusion by detailing specific preventative measures.
• Guides clinical practice for anesthesiologists and surgeons performing cell salvage procedures.
• Contributes to the understanding of managing coagulation and preventing thromboembolic events in patients undergoing massive blood replacement.