4 Anaesthesia and patient blood management

• 4.1 Volatile or total intravenous general anaesthesia?
• 4.2 Neuraxial and other major regional techniques compared with general anaesthesia
• 4.3 Type of ventilation

The major role for the anaesthetist should be an active involvement in the multidisciplinary patient blood management program, including:

• preoperative optimisation of red cell mass and coagulation status
• meticulous attention to surgical haemostasis
• minimisation of perioperative blood loss (e.g. by optimising venous and arterial pressures at the site of surgery both during and after the procedure)
• appropriate management of postoperative anaemia.

This background section focuses on the influence of various anaesthetic agents and techniques on perioperative blood loss, including:

• volatile (inhalational) versus total intravenous anaesthesia (TIVA)
• regional (mainly neuraxial) versus general anaesthesia
• spontaneous versus controlled ventilation.

Increased emphasis on preservation of arterial blood pressure, particularly in the older patient with comorbidities, has meant that the practice of controlled intraoperative hypotension is being used less often (see also Section 3.6.4 in Chapter 3).

The impact that a particular anaesthetic technique can have on blood conservation depends not only on other blood conservation strategies employed, and the experience of the anaesthetist, but also the type of surgery and other factors that contribute to bleeding, such as anticoagulants and surgical technique.