Search

Unlabelled: The objective of the study was to evaluate the role of autologous blood transfusion in current clinical practice in the Federal Republic of Germany after reunification.Methods: Questionnaires were sent to the anaesthesia departments of 684 German hospitals in January 1993. The sample consisted of 400 randomly selected hospitals from the former West Germany ("old federal states") and 284 hospitals from the former German Democratic Republic ("new federal states"). Only hospitals with more than 25 surgical beds were included in the study. The questionnaire contained 36 questions related to (1) general information on the hospital, (2) preoperative autologous blood donation (PABD), (3) preoperative plasmapheresis, (4) isovolaemic haemodilution, (5) perioperative blood salvage, and (6) general management of blood transfusion.Results: A total of 502 completed questionnaires (73%) were returned, 305 from hospitals in the "old federal states" and 197 from hospitals in the former German Democratic Republic. Nine per cent of the responding hospitals were running their own transfusion services, and 56% were located in the vicinity of a regional blood bank. The overall proportion of surgical procedures requiring perioperative blood transfusion ranged from 1% to 90% (median 10%). PABD was performed "not at all" in 18%, "rarely" in 20% "occasionally" in 27%, "frequently" in 17%, and "mostly" in 16% of the responding hospitals. The principal use of PABD was in orthopaedic surgery and cardiac surgery (83% and 70% of the departments in question, respectively). In more than 50% of the hospitals reporting, the PABD service was run by the anaesthesia department. Patients not meeting the established criteria for homologous blood donors were accepted for autologous blood donation "frequently" and "mostly" in 20% and 12% of the hospitals, respectively, but at most "occasionally" in 63% of the hospitals. Preoperative plasmapheresis was performed in 12% of the responding hospitals. Autologous fresh frozen plasma predominantly was used for volume replacement, and for prevention of coagulation disorders when major blood loss was anticipated. Isovolaemic haemodilution was performed "not at all" in 28%, "rarely" in 19%, "occasionally" in 28%, "frequently" in 16%, and "mostly" in 8% of the responding hospitals. The reasons most frequently invoked for not performing haemodilution were "too time consuming" and "too little blood-saving effect". Cell separators for perioperative blood salvage were available in 30% of the responding hospitals. Of the other hospitals not equipped with cell-washing devices, 11% performed perioperative blood salvage of unprocessed blood by means of simple collection devices. Some 80% of those hospitals using intraoperative autotransfusion devices also performed blood salvage postoperatively. The principal use of perioperative blood salvage was in cardiac surgery, orthopaedics, and vascular surgery (90%, 54%, and 54% of departments, respectively). Some 48% of the responding anaesthetists "mostly" considered haemoglobin levels of 8-10 g/dl acceptable in patients without cardiopulmonary disease, but only 18% did so in patients with cardiopulmonary disease.Conclusions: Although available in the majority of hospitals surveyed, the simple techniques of both PABD and isovolaemic haemodilution are unduly neglected in routine clinical practice. The consistent use of both of these techniques, and the careful weighing up of the indication for every single blood transfusion, would not only effectively reduce homologous blood transfusions, but also enable even small hospitals to run successful autologous transfusion programmes without expensive cell-washing and plasmapheresis devices. [ABSTRACT FROM AUTHOR]

Background and Objective: Intrathecal morphine provides effective postoperative analgesia but is associated with the risk of respiratory depression. A dose of only 0.1 mg has been shown to be optimal for effective and safe pain relief after abdominal surgery. This study was designed to determine whether the addition of 0.1 mg of morphine to the local anesthetic for spinal anesthesia produces adequate analgesia following arthroscopic knee joint surgery., Methods: A prospective, randomized, placebo-controlled, double-blind clinical trial was performed. Forty ASA I/II patients undergoing knee arthroscopy under spinal anesthesia were randomized to receive either mepivacaine 4% with 0.1 mg of morphine or mepivacaine 4% with saline (placebo) intrathecally. Postoperative analgesia consisted of intravenous morphine delivered by patient-controlled analgesia (bolus: 2 mg, lockout time: 5 min). During the study period of 24 h, pain intensity at rest and on movement (visual analogue scale, 0: no pain, 100: maximum pain), vigilance, and vital parameters were recorded every hour., Results: There were no statistically significant differences between the two groups in postoperative pain scores, morphine requirements, vigilance, blood pressure, heart rate, and breathing frequency. The patients of the morphine group required 12.3+/-10.2 mg (mean+/-SD) and those of the placebo group 11.6+/-8.4 mg of intravenous morphine from patient-controlled analgesia. The pain scores at rest and on movement were 10.0+/-8.1 and 16.0+/-12.6 in the morphine group and 8.2+/-7.9 and 11.7+/-11.3 in the placebo group. We did not observe severe side effects in any of the patients., Conclusion: Intrathecal administration of 0.1 mg of morphine does not contribute to postoperative analgesia after arthroscopic knee joint surgery.

In our hospital hyperbaric Carbostesin 0.5% (AstraZeneca) had been substituted by hyperbaric Bucain 0.5% (Curasan) and both drugs were believed to be identical in their actions.However, both local anaesthetics differ in the amount of glucose they contain. We report about three patients who underwent cesarian section under spinal anaesthesia. In two patients we observed an insufficient spread of spinal anaesthesia after administration of hyperbaric Bucain 0.5%. The third patient received the normally used combination of hyperbaric Carbostesin 0.5% and fentanyl and the subarachnoid block proceeded completely uneventfully. According to the literature the clinical efficacy of hyperbaric Carbostesin 0.5% and hyperbaric Bucain 0.5% should be identical and therefore a critical dilution of the Bucain should not have occurred because of the addition of fentanyl.

Increased perception of the risks of homologous blood transfusion has focused substantial interest on autologous blood transfusion (ABT). To evaluate the role of ABT in the Federal Republic of Germany (FRG), we conducted postal surveys of German hospitals in 1989 and 1993. In the present study, the responses of 143 hospitals in the "old" federal states (former West Germany) that replied to both of our surveys were analysed. The objective was to examine trends in ABT practice in the FRG from 1989 to 1993. The study was restricted to the "old" federal states because data for the "new" federal states (former German Democratic Republic) were not available for that period. METHODS. Data presented in this study were obtained by postal surveys of German hospitals in 1989 and 1993. Because of German reunification (3 October 1990), only hospitals in the "old" federal states were surveyed in 1989, while hospitals in both the "old" and "new" states were included in 1993. Four hundred randomly selected hospitals in the "old" federal states were included in both surveys, 143 of which responded to both. The completed questionnaires of these 143 hospitals were analysed. In addition, to estimate the magnitude of positive selection bias, the data provided by these 143 hospitals were compared with data provided by another set of 162 hospitals in the "old" federal states that replied to the 1993 but not to the 1989 survey. RESULTS. There were no significant changes from 1989 to 1993 in the 143 hospitals with respect to hospital size by number of beds and spectrum of surgical specialties. The proportion of hospitals that performed preoperative autologous blood donation grew by 20% (from 74% to 89%) and the proportion that used this technique regularly ("frequently" and "mostly") rose by 80% (from 25% to 45%). The percentage of hospitals that performed preoperative plasmapheresis had more than doubled (from 8% to 19%). The proportion that used acute isovolaemic haemodilution grew by 32% (from 62% to 82%), while those doing so regularly ("frequently" and "mostly") increased by only 17% (from 23% to 27%). The fraction of hospitals equipped with cell-washing devices grew by 29% (from 35% to 45%). General transfusion practice, as measured by acceptance of postoperative haemoglobin levels of less than 10.0 g/dl, had changed but little. CONCLUSIONS. Although the 143 hospitals are not representative on a national level, the findings of our study allow some conclusions on general trends in the "old" states of the FRG. The potential for ABT has substantially grown in the "old" states from 1989 to 1993, although more consistent advantage of this potential could be taken.

Autologous blood transfusion in animal experiments was performed already in the first half of the 19th century. These experiments, however, were not conducted to explore the feasibility of autologous blood transfusion in man, but provided only the experimental design for physiological investigations on the defibrination of blood. Blood withdrawn from the animals by phlebotomy in these experiments was retransfused either with or without defibrination. The idea of retransfusing the patient's own blood was mentioned for the first time by Eulenburg and Landois, when in 1866 they proposed to treat gas poisonings with a type of exchange transfusion (transfusion with simultaneous depletory bleeding). They suggested that the blood that would be withdrawn could be retransfused after the poisonous gases had been eliminated. The first who demonstrably considered the possibility of autologous blood transfusion in operative medicine was the Halle surgeon Richard von Volkmann in 1868. The first originally sourced autologous blood transfusion, however, was performed by the Kiel surgeon Friedrich von Esmarch who, in a case of exarticulation of the thigh at the hip joint, collected the blood that had been shed during the operation in a washbowl, defibrinated it, and reinjected it into the severed femoral vein. However, despite some further cases of autologous blood transfusion performed for various indications and in different countries, the method was unable to gain a foothold in the treatment of acute blood loss, and fell into oblivion until the Leipzig gynaecologist Johannes Thies revived interest in it in 1914. The authors surmise that the advantages of autologous blood transfusion had not been recognised in the 19th century.

Unlabelled: The objective of the study was to evaluate the role of autologous blood transfusion in current clinical practice in the Federal Republic of Germany after reunification., Methods: Questionnaires were sent to the anaesthesia departments of 684 German hospitals in January 1993. The sample consisted of 400 randomly selected hospitals from the former West Germany ("old federal states") and 284 hospitals from the former German Democratic Republic ("new federal states"). Only hospitals with more than 25 surgical beds were included in the study. The questionnaire contained 36 questions related to (1) general information on the hospital, (2) preoperative autologous blood donation (PABD), (3) preoperative plasmapheresis, (4) isovolaemic haemodilution, (5) perioperative blood salvage, and (6) general management of blood transfusion., Results: A total of 502 completed questionnaires (73%) were returned, 305 from hospitals in the "old federal states" and 197 from hospitals in the former German Democratic Republic. Nine per cent of the responding hospitals were running their own transfusion services, and 56% were located in the vicinity of a regional blood bank. The overall proportion of surgical procedures requiring perioperative blood transfusion ranged from 1% to 90% (median 10%). PABD was performed "not at all" in 18%, "rarely" in 20% "occasionally" in 27%, "frequently" in 17%, and "mostly" in 16% of the responding hospitals. The principal use of PABD was in orthopaedic surgery and cardiac surgery (83% and 70% of the departments in question, respectively). In more than 50% of the hospitals reporting, the PABD service was run by the anaesthesia department. Patients not meeting the established criteria for homologous blood donors were accepted for autologous blood donation "frequently" and "mostly" in 20% and 12% of the hospitals, respectively, but at most "occasionally" in 63% of the hospitals. Preoperative plasmapheresis was performed in 12% of the responding hospitals. Autologous fresh frozen plasma predominantly was used for volume replacement, and for prevention of coagulation disorders when major blood loss was anticipated. Isovolaemic haemodilution was performed "not at all" in 28%, "rarely" in 19%, "occasionally" in 28%, "frequently" in 16%, and "mostly" in 8% of the responding hospitals. The reasons most frequently invoked for not performing haemodilution were "too time consuming" and "too little blood-saving effect". Cell separators for perioperative blood salvage were available in 30% of the responding hospitals. Of the other hospitals not equipped with cell-washing devices, 11% performed perioperative blood salvage of unprocessed blood by means of simple collection devices. Some 80% of those hospitals using intraoperative autotransfusion devices also performed blood salvage postoperatively. The principal use of perioperative blood salvage was in cardiac surgery, orthopaedics, and vascular surgery (90%, 54%, and 54% of departments, respectively). Some 48% of the responding anaesthetists "mostly" considered haemoglobin levels of 8-10 g/dl acceptable in patients without cardiopulmonary disease, but only 18% did so in patients with cardiopulmonary disease., Conclusions: Although available in the majority of hospitals surveyed, the simple techniques of both PABD and isovolaemic haemodilution are unduly neglected in routine clinical practice. The consistent use of both of these techniques, and the careful weighing up of the indication for every single blood transfusion, would not only effectively reduce homologous blood transfusions, but also enable even small hospitals to run successful autologous transfusion programmes without expensive cell-washing and plasmapheresis devices.

The study was designed to evaluate the role of autologous blood transfusion in current clinical practice. METHODS. Standardized questionnaires were distributed to the anesthesia departments of 421 randomly selected hospitals in the 'old' Federal Republic of Germany and West Berlin in August 1989. The questionnaires contained 26 questions relating to (1) the particular hospital, (2) preoperative autologous blood donation (PABD), (3) preoperative plasmapheresis, (4) isovolemic hemodilution, (5) intra- and postoperative autotransfusion, (6) general practice followed in blood transfusion, and (7) blood salvage in children. RESULTS. In all, 207 completed questionnaires (49%) were returned, 12% of which came from university hospitals, 25% from hospitals with more than 500 beds, 58% from hospitals with fewer than 500 beds and 5% from smaller specialized hospitals. Over half (52%) of the responding hospitals were running their own transfusion services or were located in the vicinity of a regional blood bank. The overall proportion of surgical procedures requiring perioperative blood transfusions was 10%. PABD was performed "not at all" in 24% of the hospitals, "rarely" in 28%, "occasionally" in 24%, "frequently" in 10%, and "routinely" in 13%. PABD was standard in 75% of the departments of orthopedic surgery, in 68% of the departments of cardiac surgery, and in 33% of the departments of vascular surgery. In two-thirds of the hospitals reporting the use of PABD, the anesthesia departments were in charge of the autologous blood service. For 64% of the hospitals, liquid storage of whole blood was reported as the standard technique. Patients normally not eligible for homologous blood donation according to established donor criteria were accepted for autologous blood donation at most "occasionally" in 60% of the hospitals, but "frequently" or "mostly" in 36%. Preoperative autologous plasmapheresis was performed when major intraoperative blood loss was anticipated in 12% of the hospitals. Isovolemic hemodilution was performed "not at all" in 30% of the hospitals, "rarely" in 17%, "occasionally" in 25%, "frequently" in 14%, and "mostly" in 12%. The reasons most frequently given for not performing hemodilution were "too time-consuming" (41%) and "too little blood-saving effect" (32%). Autotransfusion devices were available in 40% of the hospitals. Others deemed such devices "badly needed" (5%) or "desirable" (43%), while 45% found them "not necessary." The principal use of intraoperative autotransfusion was in cardiac surgery (79% of the departments), orthopedics (47% of the departments) and vascular surgery (45% of the departments). In 29% of the responding hospitals autotransfusion devices were also used for postoperative autotransfusion ("seldom" in 7%, "occasionally" in 10%, "frequently" in 6%, "mostly" in 6%). In the absence of cardiopulmonary disease, hemoglobin concentrations below 8-10 g/dl were considered an indication for blood transfusion. In patients with compromised cardiopulmonary function the lowest acceptable level was 10-12 g/dl. Blood salvage techniques are obviously rarely used in children. Experiences with PABD in children were reported by 14.5% of the hospitals, experience with isovolemic hemodilution by 22% and with intra- and postoperative autotransfusion in 18% and 12.5% of the hospitals, respectively. Preoperative plasmapheresis was performed in children in 3.5% of the hospitals. CONCLUSIONS. Although the present sample is not representative on a national level, our findings allow the conclusion that the simple techniques of both preoperative autologous blood donation and isovolemic hemodilution are unduly neglected in surgical and anesthetic practice, whereas even smaller hospitals are fairly well equipped with sophisticated autotransfusion devices.