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BACKGROUND: Although blood utilization has been under considerable scrutiny for the past two decades, particularly for surgery, studies comparing perioperative blood transfusion practices between countries are rare, and the evolution of international standards remains unknown. Therefore, the objective of this evaluation was to compare the perioperative transfusion of blood components in cardiac surgery in multiple centers in different countries. STUDY DESIGN AND METHODS: Transfusion practice was investigated prospectively in 70 centers among 16 countries. A total of 5065 randomly selected cardiac surgery patients of the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study were evaluated. Utilization of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelets (PLTs) was assessed daily, before, during, and after surgery until hospital discharge. RESULTS: Intraoperative RBC transfusion varied from 9 to 100 percent among the 16 countries, and 25 to 87 percent postoperatively (percentage of transfused patients). Similarly, frequency of transfusion of FFP varied from 0 to 98 percent intraoperatively and 3 to 95 percent postoperatively, and PLT transfusion from 0 to 51 and 0 to 39 percent, respectively. Moreover, there were not only marked differences in transfusion rates between centers in different countries but also in interinstitutional comparison of multiple centers within countries. CONCLUSION: In cardiac surgical patients, marked variability in transfusion practice exists between centers in various countries and suggests differences in perioperative practice patterns as well as possible inappropriate use. International standardization of perioperative practice patterns as well as transfusion regimes appears necessary.

SUMMARY When IAT is used, the patient's shed blood is collected continuously from the wound site during surgery. The salvaged red cells are stored in a dedicated reservoir and subsequently processed by cell separation (continuous centrifugation), washed with saline, concentrated and retransfused to the patient. In the context of perioperative blood saving strategies, IAT has gained standard-of-care status in many surgical procedures as it is especially cost-effective when the anticipated intraoperative blood loss is likely to exceed 1000 mL (major orthopedic, cardiac, vascular and emergency trauma surgery). IAT is not primarily recommended for cancer surgery or whenever the operative field is contaminated. Intraoperative plasmapheresis (IP) is used in cardiac surgery to minimize coagulation deficiencies caused by the traumatizing effects of cardiopulmonary bypass (CPB) on platelets. A substantial amount of the patient's circulating platelets is withdrawn prior to heparinization and initiation of CPB. The collected autologous platelet-rich plasma is then stored at room temperature, preserving platelet function and plasmatic coagulation factors, and retransfused to the patient after heparin reversal. There is controversy about the actual blood saving benefit of IP, but this method may be effective in complicated procedures precipitating high blood loss and long CPB times. In addition, IP may be used when other autologous whole blood harvesting techniques are not an option.

Background: Although desflurane (DES) and sevoflurane (SEV) have desirable features for use in patients with coronary artery disease, their effects on ventricular dysrhythmias following infarction are less known. We therefore examined the effects of DES and SEV upon spontaneous postinfarction ventricular dysrhythmias in dogs, and compared those effects to the well-established antidysrhythmic effects of halothane (HAL) in this model. Methods: After institutional approval, the left anterior descending coronary artery was ligated in 16 adult mongrel dogs during isoflurane anesthesia. All dogs developed acute myocardial infarction and severe ventricular tachydysrhythmias. Twenty-two hours after infarction, dogs were anesthetized at 1.5 MAC with desflurane (10.8%) followed by sevoflurane (3.5%) in the treatment group (n=10), or halothane (1.3%) in the other group (n=6). Anesthetic gases were allowed to equilibrate for at least 20 min at each end-tidal concentration. At this time, the ECG was recorded for 9 min and evaluated for the number of ventricular ectopic and sinoatrial beats and summed duration of ventricular tachycardia. Results: DES and SEV reduced the average rate of total ventricular ectopic beats by 40 ±4% and 42 ±4%, respectively. HAL decreased total ventricular ectopic rate by 59 ±6% and 62 ±5% after durations of anesthesia comparable to DES and SEV, respectively. Decreases in dysrhythmia in the presence of DES and SEV were significantly smaller than those produced by HAL after a comparable total duration of anesthesia. Conclusions: DES and SEV inhibit spontaneous postinfarction ventricular dysrhythmias, although attenuation of dysrhythmias was smaller than the inhibition during comparable doses of HAL.