Abstract
The authors attempted to determine the relative importance of factors that influence bleeding during and after spinal fusion. Data from 30 ASA I patients with idiopathic scoliosis were prospectively collected and analyzed. Intraoperative bleeding was 1971 ± 831 ml (mean ± SD) (61.5 ± 27% of estimated blood volume (EBV) and correlated with the number of fused vertebrae (r = 0.66, P < 0.0001) and the duration of surgery (r = 0.46, P = 0.0105). There was no correlation between intraoperative bleeding and the Cobb curve angle (43 to 86°), the mean arterial blood pressure (MAP) (63 to 86 mmHg), the central venous pressure (CVP), the quantity of epinephrine infiltrated, muscle relaxants or opioids used, nor in the type of opioids used, the minimal body temperature or whether stored or autologous blood was used. Postoperative bleeding was 1383 ± 369 ml (43.1 ± 11.7% of EBV) and correlated with the length of time the Hemovac drain was in place (r = 0.40, P = 0.0285) and MAP (r = 0.40, P = 0.0285). There was no correlation between postoperative and intraoperative bleeding nor in the number of fused vertebrae. Six patients had greater postoperative than intraoperative bleeding. The total bleeding (intra-plus postoperative) was 3347 ± 920 ml (104.2 ± 30.6 of EBV) and correlated with the number of fused vertebrae (r = 0.63, P = 0.0001) and with the duration of surgery (r = 0.42, P = 0.0208). We conclude that the number of fused vertebrae is the key factor in predicting intraoperative and total bleeding. Postoperative bleeding is considerable (up to 76.9% of EBV). No other factors allow for adequate prediction of postoperative bleeding and these patients must be kept under strict surveillance after surgery.
Résumé
Cette étude avait pour but de déterminer l’importance relative des facteurs qui influencent les pertes sanguines per et postopératoires au cours des arthrodèses vertébrales postérieures. Les données de 30 patients porteurs de scoliose idiopathique ont été recueillies prospectivement puis analysées. Le saignement intraopératoire était de 1971 ± 831 ml (moyenne ± DS) (61.5 ± 27% du volume sanguin estimé (VSE)) et était relié au nombre de vertèbres fusionnées (r = 0.66, P < 0.0001) et à la durée de la chirurgie (r = 0.46, P = 0.0105). Le saignement intraopératoire n’était pas relié au degré de courbure (43 à 86°), ni à la pression artérielle moyenne (PAM) (63 à 86 mmHg), à la pression veineuse centrale (PVC), à la quantité d’épinéphrine, de relaxants neuro- musculaires ou de morphiniques utilisés, ni à la sorte de morphinique utilisé, à la temperature corporelle minimale ou au type de sang administré. Le saignement post-opératoire était de 1383 ± 369 ml (43.1 ± 11.7% du VSE) et était relié à la durée du maintien d’un drain (r = 0.40, P = 0.0285) et à la PAM (r = 0.40, P = 0.0285). Le saignement post-opératoire n’était pas relié au saignement intra-opératoire ni au nombre de vertèbres fusionnées. Six patients ont eu un saignement post-opératoire supérieur au saignement intra-opératoire. Le saignement total (intra et postopératoire) était de 3347 ± 920 ml (104.2 ± 30.6% du VSE) et était relié au nombre de vertèbres fusionnées (r = 0.63, P = 0.0001) ainsi qu’à la durée de la chirurgie (r = 0.42, P = 0.0208). Nous concluons que le nombre de vertèbres fusionnées est le meilleur facteur pour prédire le saignement intraopératoire et le saignement total. Le saignement post-opératoire est élevé (jusqu’à 76.9% du VSE). Il n’y a pas d’autre facteur utile pouvant prédire le saignement post-opératoire et tous les patients doivent être surveillés étroitement en post-opératoire.
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Guay, J., Haig, M., Lortie, L. et al. Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 41, 775–781 (1994). https://doi.org/10.1007/BF03011583
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DOI: https://doi.org/10.1007/BF03011583