Transfusion practice in neuroanesthesia

Perioperative transfusion thresholds in the neurosurgical patient are undefined. Many neurosurgical procedures are associated with significant risk of bleeding. This review will summarize the current understanding of blood transfusion in the neurosurgical patient, as well as other blood component therapies and blood conservation strategies.

Transfusion of red blood cells has been demonstrated to improve cerebral oxygen delivery. Clinical studies on transfusion-related morbidity and mortality in the neurosurgical patient are limited. Recent findings in both subarachnoid hemorrhage and traumatic brain injured patients have shown worse outcomes in patients with anemia (Hb <9.0 g/dl) yet transfusion of red blood cells may not be associated with improved outcome.

Perioperative transfusion management for intracranial neurosurgical procedures presents the clinician with multiple challenges. Clinical evidence is sparse with view to an optimal hemoglobin level, yet anemia is known to be a predictor of poor outcome in many neurosurgical patients. Transfusion thresholds from other patient populations may not apply to this group and further prospective investigations are desperately needed. Until then, clinicians should focus on an individualized assessment of anemia tolerance, consider blood conservation strategies and understand the potential risks and benefits of blood transfusion.