Platelet-rich plasma reduces postoperative blood loss after cardiopulmonary bypass

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Taggart DP, Siddiqui A, Wheatly DJ: Luw-dose preoperative aspirin therapy, postoperative blood loss, and transfusion requirements. Ann Thorac Surg 50~425428,199O The effects of three low-dose preoperative aspirin regimens on postoperative blood loss, transfusion requirement, and length of hospita1 stay were determined in a prospective study of 202 patients undergoing elective coronary revascularization. One hundred one patients had been prescribed daily aspirin by their cardiologists: 44 patients received 75 mg, 28 patients received 150 mg, and 29 patients received 300 mg. One hundred one nonaspirin-treated patients served as controls. Average postoperative blood loss in the control group was 970 mL. This was increased in all aspirin-treated groups (1,150 mL-75 mg, 1,360 mL-150 mg, 1,100 mL-300 mg). The median requirement for blood transfusion in the control group was two units of red blood cel1 concentrates. This was increased in al1 three aspirin-treated groups (4 units-75 and 250 mg, 3 units-300 mg). Fresh frozen plasma, platelets, and cryoprecipitate were administered to 20 patients in the aspirin groups compared with 5 patients in the control group. The incidence of reoperation for bleeding was not different between the two groups. Surgical bleeding was found in al1 cases. Postoperative hospita] stay was similar.

LITERATURE REVIEW

Estrera AS, Pass LJ, Platt MR: Systemic arterial embolism in penetrating lung injury. Ann Thorac Surg 50:257-261,199O In this clinical report, the occasional but catastrophic development of systemic air embolization occurring following isolatcd penetrating lung injury is brought to our attention. This complication developed in nine patients observed at Parkland Memorial Hospita1 in Dallas over an 8-year period. Eight of nine patients presented in profound shock or experienced cardiac arrest, fìve had significant hemoptysis. AII were on positive-pressure ventilation at the time of presentation. The diagnosis of systemic air embolization was made by direct visualization of air in the coronary vessels in all nine patients. In three, air was aspirated from the left ventricle and aortic root. Six of the nine patients died. The occurrence of this infrequent but catastrophic complication may he kept in mind when the patient with an apparently straightforward penetrating lung injury develops cardiovdscular collapse out of proportion to chest tube blood drainage. Aggressive resuscitation including thoracotomy, clamping the hilum of the suspected lung, Trendelenburg position, reduced ventilatory pressure. and vigorous direct cardiac compression are important.

REVIEW ARTICLES

Johnson RG, Murphy JM: The role of desmopressin in reducing blood loss during lumbar fusions. Surg Gynecol Obstet 171:223-226,199O This study represents unenlightening science, which may attract the attention of our surgical colleagues. In this unblinded, nonrandomized study, the effect of the postanesthetic induction administration of desmopressin (20 kg) was investigated in 52 operations and compared with a control group undergoing 63 procedures. Intraoperative blood loss was similar in the two patient groups and postoperative drainage was greater in the desmopressin-treated patients. Nonetheless and without explanation, treated patients received less than one half the number of autologous transfusions than the control group. In the subgroup of patients having posterior fusion with internal fìxation at three levels, intraoperative blood loss was reduced by desmopressin treatment (1060 mL v 739 mL). Statistical analysis was not performed. The authors conclude that desmopressin has a role in lumbar fusions when anticipated blood loss greater than 1,000 mL is expected.

DelRossi AJ, Cernaianu AC, Vertrees RA, et al: Platelet-rich plasma reduces postoperative blood loss after cardiopulmonary bypass. J Thorac Cardiovasc Surg 100:281-286,199O In this prospective, randomized, unblinded study conducted in 18 patients undergoing cardiac surgery, intraoperative plasma sequestration and reinfusion of platelet-rich plasma was investigated. After heparin neutralization, autologous platelet-rich plasma, 250 mL (representing 9% of total platelet volume), was reinfused in 9 patients. Platelet-rich plasma-reinfused patients had significantly higher platelet counts postbypass (136 v 95 x lni), significantly less 24-hour blood loss (408 v 630 mL), and received 65% less banked blood products. It is of note that the volumes of washed centrifuged autogolous blood and homologous packed red cells administered to the two groups are identical. The differente in number of banked blood units administered to the two patient groups is accounted for by the administration of 6 times the volume of fresh frozen plasma to the control group as administered to the platelet-rich plasma-treated patients.

Matsuzaki M, Toma Y, Kusukawa R: Clinical applications of transesophageal echocardiography. Circulation 82:709-722,199O This succinct clinical review of transesophageal echocardiography (TEE) begins with a description of examination technique, includingorientation of the reader to the various echocardiography images obtainable. A diagram of common scan planes and their resulting images is presented. The authors then discuss clinical applications of TEE. Of specific relevante to the anesthesiologist are the segments concerning perioperative monitoring in adult patients and intraoperative monitoring of congenital heart disease in pediatrie patients. The risks of TEE are reviewed and feit to be few. The authors conclude the review with a description of the technological instrumentation advances ahead.

Bolli R: Mechanisms of myocardial “stunning.” Circulation 82:723-738,199O This article in Circulution’s Research Advances series critically evaluates proposed pathophysiological mechanisms resulting in the reversible postischemic myocardial dysfunction termed “stunning.” Of the mechanisms proposed for myocardial stunning, three are reported to be most plausible: generation of oxygen radicals, calcium overload, and excitation contraction uncoupling. On the basis on this synthesis, it may be believed that myocardial stunning may be attenuated and the resulting ventricular dysfunction prevented by pharmacological manipulations targeted at these specific mechanisms. This article for the inquisitive anesthesiologist suggests that antioxidants may soon be administered to patients prior to reperfusion.

ACKNOWLEDGMENT Articles reviewed in this issue were selected from those published in the following journals: American Heart Joumal; American Joumal of Cardiologv; Annals tif Thoracic Sutgety; Archives of Surgegery;Joumal of Thoracic and Cardiovascular Sutgev; and Surgety, Gynecology and Obstettics.