Orthopedics
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Blood management in orthopedic surgery is no longer an option; it is a requirement. The combination of patient desire to avoid transfusion, increasing evidence of multiple risks, decreasing blood supplies, and increasing costs mandate attention. This article addresses the balance of risk versus benefit in blood transfusion and presents a perioperative plan of blood management for patients undergoing orthopedic surgery.
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Aprotinin is a potent pharmacological agent that reduces bleeding. In current surgical practices, the rate of blood transfusions has decreased with the use of aprotinin. Recently, studies using aprotinin have been conducted in orthopedic surgery. ⋯ One adverse effect was the potential occurrence of an anaphylactoid reaction. Prophylactic administration of aprotinin should be considered in extensive spine surgery and in high-risk orthopedic operations. The decision to use aprotinin can be guided by a risk/benefit analysis.
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Based on a literature review, this article evaluates the efficacy of aprotinin to limit blood transfusion during spine surgery. Most prospective studies confirm this effect. However, broader studies are required to evaluate adverse effects. ⋯ The cost of the medication has to be balanced with the cost of blood transfusion. A careful use of aprotinin allows a surgeon dealing with high-risk patients to avoid or limit the use of transfusions. For patients who are not high-risk, aprotinin should be avoided until other questions are answered.
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Cardiac surgery and cardiopulmonary bypass produces bleeding and the need for allogenic blood product transfusions in many patients. Blood conservation is important in the perioperative management of patients. ⋯ Full-dose aprotinin significantly reduces postoperative blood loss and has been demonstrated in multiple prospective blinded studies to be safe and effective. One of the major adverse effects is anaphylaxis that occurs on re-exposure to aprotinin.
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Elective hip or knee arthroplasty is considered a relatively safe orthopedic procedure. However, given the number of procedures performed, catastrophic complications, such as death, occur. Between January 1995 and March 2001, 3438 patients underwent elective hip or knee arthroplasty at our institution. ⋯ The American Society of Anesthesiologists (ASA) score was significantly related to the incidence of postoperative death. Specifically, ASA class III patients were more likely to encounter postoperative death. Additionally, a higher rate of postoperative complications occurred in the deceased group.