Surgery News - June 2008 - (Page 10)

10 GENERAL SURGERY SURGERY NEWS • J U N E 2 0 0 8 Hemodilution Technique a Plus for Liver Resection BY BRUCE JANCIN Else vier Global Medical Ne ws N E W Y O R K — Acute normovolemic hemodilution markedly reduced the need for blood products, compared with standard intraoperative management in a randomized trial of patients undergoing major hepatic resection. In the 130-patient study, the red blood cell transfusion rate in patients managed with ANH was half that of patients who received standard management, Dr. William H. Jarnagin reported at the annual meeting of the American Surgical Association. ANH “should be used routinely when moderate to high blood loss is anticipated,” concluded Dr. Jarnagin, vice chair of surgical services and chief of the hepatopancreatobiliary service at Memorial Sloan-Kettering Cancer Center, New York. Hepatic resection often entails major blood loss. While transfusion of allogeneic blood products can often be lifesaving, it has numerous downsides, among them in- creased risks of blood-borne infection, acute lung injury, transfusion reactions, and immunomodulation, as well as much higher direct and indirect costs of care. ANH is a low-tech blood conservation technique that avoids exposing patients to the risks of allogeneic transfusion while preserving blood bank supplies for the situations where they are truly needed. ANH involves intraoperative removal of whole blood by gravity collection prior to starting the resection. The lost volume is replaced with crystalloid and colloid. That 3% commodities allocation NEW FUND ALLOCATION A 3% commodities allocation has been added to SDIF in an effort to further align its asset allocation with that of the ACS endowment. The commodities component allows SDIF shareholders to obtain exposure to various types of commodities, including industrial and precious metals, agriculture, livestock and energy. Commodities exposure adds an asset class to SDIF that provides further diversiﬁcation, and one that historically has a negative correlation to stocks and bonds. For more information about SDIF, please contact Tom Kiley at 312/202-5019, tkiley@facs.org, or Savi Pai at 312/202-5056, spai@facs.org. An investor should consider the charges, risks, expenses and investment objective carefully before investing. For more information or for a free copy of the prospectus, please download a copy at www.surgeonsfund.com or call 1-800-208-6070 and a copy will be mailed to you. Read the prospectus carefully before you invest or send money. SDIF is distributed by Ultimus Fund Distributors, LLC, 225 Pictoria Dr., Suite 450, Cincinnati, OH 45246. The phone number is 513-587-3400. way a smaller volume of the patient’s red blood cell (RBC) mass is lost per volume of surgical blood lost. At the end of the operation, after hemostasis is attained, the patient’s blood is transfused back. “Compared with other blood conservation strategies, ANH has several advantages: It is technically and logistically simple; and there are minimal equipment requirements, no storage or administrative costs, no delay in procedure scheduling, and no waste of autologous units,” Dr. Jarnagin said. He presented a single-center prospective trial involving 130 patients undergoing resection The red blood cell of three or more hepatic segments transfusion rate who were randomwas 25.4% in ized to ANH or controls and standard intraoper12.7% with ANH, ative management. a 50% reduction. In the ANH group, DR. JARNAGIN blood was removed to a target hemoglobin of 8.0 g/dL. Patients had a median of 2,250 mL of blood removed; the hemodilution took 37 minutes on average to complete. The RBC transfusion rate was 25.4% in controls and 12.7% with ANH, for a 50% reduction. Intraoperatively, a hemoglobin below 7.0 g/dL required transfusion; only 1.6% of patients managed with ANH required an intraoperative transfusion, versus 10.4% with standard management. H i s t o r i c a l l y, roughly 50% of patients at Sloan-Kettering undergoing major hepatic resection have required allogeneic transfusions. With c o n t e m p o r a r y The well-designed techniques, the rate study provides in the usual-care convincing group in this study evidence that was just half that. ANH is safe “In fact, ANH was and effective. not necessary in DR. CHAPMAN many of our patients,” the surgeon noted. ANH proved most useful for patients with an operative blood loss of at least 800 mL, which was actually the median blood loss in the study. Among that population, 42.4% of controls required allogeneic RBC transfusion, compared with 18.2% in the ANH group. Moreover, only 21.1% of patients in the ANH group required fresh frozen plasma, compared with 48.3% on standard intraoperative management. Sixty-day major morbidity rates were similar at about 30% in the two study arms. Discussant Dr. William C. Chapman, an ACS Fellow, said the well-designed study provides convincing evidence that ANH is safe and effective. As a result, ANH will be instituted at many centers in selected highrisk patients, said Dr. Chapman, professor of surgery and chief of the section of transplantation at Washington University, St. Louis. http://www.surgeonsfund.com http://www.surgeonsfund.com

Table of Contents Feed for the Digital Edition of Surgery News - June 2008

Surgery News - June 2008 Contents Work Hours New Digs Banking Blood Improved Imaging

Surgery News - June 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.