Abstract
A variety of techniques can aid the anaesthetist in reducing requirements for perioperative blood products. These include careful preoperative assessment of the patient, and employing techniques during surgery which reduce the blood pressure and help preserve the normal haemostatic mechanism. If the level to which haematocrit will be permitted to decrease is decided, then physiological crystalloid and/or colloid solutions may be used to maintain circulating volume. Where large volumes of fluids are required cardiac filling pressures should be monitored because of the complex nature of the fluid shifts which occur. There is no evidence that any one fluid (physiological crystalloids, colloids) is better than any other in terms of the incidence of perioperative morbidity.
Résumé
L’anesthesiste dispose de plusieurs outils lui permettant de minimiser les besoins en derives sanguins en période périopératoire. Après une évaluation préopératoire serrée, il peut employer une technique qui diminue la pression artérielle tout en préservant les mécanismes de l’hémostase. Apres avoir déterminé l’hémalocrite minimale acceptable, l’anesthésiste peut se servir de solutions de cristalloïdes ou de colloïdes afin de maintenir un volume circulant normal. S’il doit en utiliser de grandes quantités, il est préférable de mesurer les pressions de remplissage cardiaques car il est difficile de prédire avec exactitude les flux liquidiens. Par ailleurs, que l’on emploie des cristalloïdes ou des colloïdes ne semble faire aucune différence quant à la morbidité péri-opératoire.
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Report of Symposium at C.A.S. Annual Meeting, June 1991, Vancouver.
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Ramsay, J.G. Methods of reducing blood loss and non-blood substitutes. Can J Anaesth 38, 595–599 (1991). https://doi.org/10.1007/BF03008191
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DOI: https://doi.org/10.1007/BF03008191