3.6 Effect of perioperative strategies that minimise blood loss
Question 3 (Interventional) POQ3
In patients undergoing surgery, what is the effect of perioperative strategies that minimise blood loss on morbidity, mortality and blood transfusion?
Meticulous surgical technique is the cornerstone of intraoperative blood conservation. Additional measures contributing to surgical haemostasis are summarised in Box 3.1.
Box3.1 Surgical haemostasis options
- Careful planning of actual surgical procedure, taking account of blood conservation
- Vascular conserving anatomical operative approaches
- Minimally invasive surgery
- Positioning of patient to reduce venous and arterial pressure in the surgical field
- Limb exsanguination before the application of a tourniquet
- Use of a surgical tourniquet at correct limb occlusion pressure to enable surgeons to work in a bloodless operative field
- Perioperative use of vasoconstrictors such as ropivacaine or dilute adrenaline (+/– local anaesthetics)
- Electrosurgical diathermy and harmonic scalpel techniques (e.g. argon beam, cavitational ultrasonic surgical aspirator [CUSA])
- Controlled intraoperative hypotension
- Use of topical agents (e.g. thrombin, collagen, fibrin glue, tranexamic acid)145
- Systemic antifibrinolytics (e.g. tranexamic acid)
- Consideration of the use of reduced prime volume and smaller circuits in patients undergoing cardiopulmonary bypass (retrograde autologous priming)146