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[Anesthesia for pediatric open heart surgery without transfusion]

Y Ohnishi1, Y Koyama, Y Hayashi

  • 1Clinical Engineering National Cardiovascular Center, Suita.

Masui. the Japanese Journal of Anesthesiology
|February 1, 1997
PubMed
Summary

Successful open heart surgery without blood transfusion in pediatric patients is achievable. Key factors include patient weight over 9 kg, cardiopulmonary bypass time under 120 minutes, and minimal intraoperative bleeding (<10 ml.kg-1).

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Anesthesiology
  • Transfusion Medicine

Background:

  • Pediatric open heart surgery often necessitates blood transfusions.
  • Optimizing anesthetic management to minimize or avoid transfusions is crucial for patient outcomes.
  • Understanding factors influencing transfusion requirements is essential for surgical planning.

Purpose of the Study:

  • To identify critical factors for successful anesthetic management of pediatric open heart surgery without blood transfusion.
  • To evaluate the outcomes and complications associated with different transfusion volumes in pediatric cardiac surgery.

Main Methods:

  • Retrospective review of 50 pediatric patients undergoing open heart surgery (weight 6.5-12 kg).
  • Analysis of anesthetic management, cardiopulmonary bypass duration, intraoperative bleeding, and transfusion requirements.

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  • Comparison of outcomes between patients receiving no transfusion, minimal transfusion, and massive transfusion.

    • Main Results:

    • Twenty-six patients (52%) had no transfusion, nine (18%) required <30 ml.kg-1, and 15 (30%) needed >50 ml.kg-1.
    • Factors for successful non-transfusion included patient weight ≥9 kg, cardiopulmonary bypass <120 minutes, and intraoperative bleeding <10 ml.kg-1.
    • Patients without transfusion showed improved urine output, reduced bleeding, more concentrated platelets, and better respiratory status post-surgery.

    Conclusions:

    • Anesthetic management strategies can significantly reduce or eliminate the need for blood transfusion in pediatric open heart surgery.
    • Avoiding transfusion is associated with superior perioperative outcomes.
    • Minimizing transfusion, even when unavoidable, is linked to better patient results, with washed red blood cells being a favorable option.