[Blood saving in pediatric orthopedics. A study of 145 posterior vertebral arthrodesis]

The authors review 145 operations utilizing the Cotrel-Dubousset technique for scoliosis and/or cyphosis over a period of 4 years. From 1985 to 1989, the number of patients who received no homologous blood rose from 0% to 85% for the totality of cases. Inversely, the average quantity per patient of homologous blood used for transfusion decreased from 3,564 ml to 194 ml, ie. -94%. Among the 145 operated patients, 47 (33%) have never received a transfusion, whether or not an autotransfusion procedure was planned; out of the 41 children prepared with preoperative autologous sampling, 39 (97%) received no homologous blood. The authors study the various means used to achieve these results in a particularly hemorrhagic surgical procedure: low blood pressure techniques, intraoperative installation and warming, peroperative recovery of blood, decrease in duration and bleeding using natural coral to avoid removing an iliac bone graft, study of evoked potentials to prevent intraoperative awakening, better postoperative control of bleeding by means of an original drain tube. As a conclusion, they state that, owing to better coordination between surgery, anesthesiology and blood biology, such definite progress may be extended to other operations in future.