Bloodless (liver) surgery? The anesthetist's view.

Area of Science:

• Hepatobiliary Surgery
• Transfusion Medicine
• Anesthesiology

Background:

• Growing literature on blood conservation and transfusion guidelines highlights the need for strategies to minimize perioperative blood loss.
• The necessity of 'bloodless liver surgery' or, more accurately, minimizing blood loss and transfusion requirements, is under continuous evaluation.

Purpose of the Study:

• To evaluate the necessity and components of a successful bloodless surgery program, particularly in liver surgery.
• To assess current strategies for reducing perioperative blood loss and transfusion dependency.

Main Methods:

• Systematic review of key literature using PubMed and Cochrane Database of Systematic Reviews.
• Cross-referencing of relevant articles to ensure comprehensive analysis.

Main Results:

• A continued need exists to reduce allogeneic blood transfusions.
• Preoperative autologous donation, defined transfusion triggers, pharmacological and non-pharmacological methods to reduce surgical bleeding, hemodilution, and cell salvage are key components.
• Postoperative re-transfusion strategies are also vital for bloodless surgery programs.

Conclusions:

• Successful implementation of bloodless surgery requires a comprehensive, multidisciplinary effort across the entire patient care continuum.
• Surgeons play a pivotal role in tailoring bloodless surgery programs to individual patient needs.