[Anesthetic management using auto-transfusion and hypothermia for massive bleeding].

Area of Science:

• Anesthesiology
• Surgical Oncology
• Critical Care Medicine

Background:

• A 51-year-old female patient presented with hypovolemic shock due to internal iliac artery bleeding, a complication of prior cervical cancer radiotherapy.
• The patient required emergency enterectomy and vascular repair under general anesthesia.

Observation:

• Massive intraoperative hemorrhage occurred, with blood loss exceeding 6,000 ml in the first two hours.
• Hemoglobin levels dropped to 3.8 g/dL despite transfusion of 38 units of packed red blood cells.
• Intraoperative blood salvage (Cell Saver) and mild hypothermia were implemented.

Findings:

• Total blood loss reached approximately 10,000 ml, with a total transfused volume of 8,740 ml.
• The patient experienced no postoperative neurological deficits or systemic infections.
• Cell Saver likely minimized further hemoglobin loss, and mild hypothermia may have protected against cerebral ischemia.

Implications:

• Intraoperative blood salvage can be a life-saving intervention in managing massive hemorrhage, even in complex surgical cases.
• Mild hypothermia may offer neuroprotection during major surgery with significant blood loss.
• Further research is warranted on the safety and efficacy of cell salvage in oncology patients, despite current controversies.