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Intraoperative hemodynamic changes. 145 min: CPB started, 185 min: regional perfusion started, 205 min: regional perfusion stopped, 235 min: mechanical ventilation started, 265 min: sodium ntroprusside infusion stopped, 310 min: epinephrine infusion started.
Source publication
In small infants or neonates, open heart surgery without transfusion can have many risks regarding inadequate oxygen delivery and coagulopathy. However, if parents refuse blood transfusion, cardiac surgery without transfusion should be considered. We report a case of bloodless cardiac surgery in a 2.89 kg neonate with Jehovah's Witness parents. Blo...
Context in source publication
Context 1
... rate of dobutamine was increased to 7 μg/kg/min, and the continuous infusion of epinephrine was started at 0.05 μg/kg/min because of hemodynamic instability. Intermittently, a bolus of epinephrine and calcium chloride was injected for the control of blood pressure. Intraoperative hemodynamic changes and the nasopharyngeal temperature are shown in Fig. 2 and Fig. 3. After weaning from the CPB, the cerebral oximeter values decreased and maintained relatively low levels despite a trial of increased cardiac output and maintenance of ...Similar publications
The objective of this study was to perform an audit of the use of homologous blood and blood products in patients undergoing open-heart surgery by a single surgical team that follows an in-house protocol for blood conservation. The hospital records of 310 consecutive patients (age )15 years) undergoing open-heart surgery over a period of 8 months w...
Background: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah’s Witness patients refusing blood transfusion to those in non-Jehovah’s Witness patients without any transfusion limitations. Methods: From 2005 to 2014, 25 Jehovah’s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twent...
Citations
... Most studies on the perioperative management of a JW patient concentrate on oral iron substitution and intraoperative normovolemic hemodilution, respectively, as well as the use of autotransfusion techniques. For example, without focusing on hemodynamic optimization, McCartney et al. were able to show that the abovementioned therapeutic actions were already associated with an improved clinical outcome after cardiac surgery of JWs [11][12][13]. Also, several case reports have supported preoperative EPO administration and blood-saving surgical techniques [14]. Today, even though the clinical implementation of these strategies is commonly applicable, it should also be focused on individual hemodynamic stabilization. ...
Background
The Hypotension Prediction Index (HPI) displays an innovative monitoring tool which predicts intraoperative hypotension before its onset.
Case presentation
We report the case of an 84-year-old Caucasian woman undergoing major spinal surgery with no possibility for the transfer of blood products given her status as a Jehovah’s Witness. The hemodynamic treatment algorithm we employed was based on HPI and resulted in a high degree of hemodynamic stability during the surgical procedure. Further, the patient was not at risk for either hypo- or hypervolemia, conditions which might have caused dilution anemia. By using HPI as a tool for patient blood management, it was possible to reduce the incidence of intraoperative hypotension to a minimum.
Conclusions
In sum, this HPI-based treatment algorithm represents a useful application for the treatment of complex anesthesia and perioperative patient blood management. It is a simple but powerful extension of standard monitoring for the prevention of intraoperative hypotension.
... undergoing open heart surgery with the development of CPB management and transfusion reduction strategies. CPB in pediatric cardiac surgery exposes children to severe hypothermia, hemodilution, and increase the blood vessels permeability because of the infl ammatory reaction due to surface contact activation, which leads to unfavorable alterations such as hemodynamics changes [13][14][15][16]. Total body water increases as a result of capillary permeability which often leads to tissue edema, followed by multiple organ dysfunctions principally in lungs, heart, and brain [17,18]. ...
Performing safe cardiac surgery in neonates or infants whose parents are Jehovah's Witnesses is only possible in a coordinated team approach. An unconditional prerequisite is a cardiopulmonary bypass (CPB) circuit with a very low priming volume to minimize hemodilution. In the past decade, we have developed a functional blood-sparing approach at our institution. The extracorporeal circuit was miniaturized. This had to be recently adapted, faced with a challenge associated with the switch to high-volume crystalloid cardioplegia. A filtration circuit was added. Here, we report an open heart surgery on three consecutive children of Jehovah's Witness parents with a body weight of 2.7, 4.5, and 4.8 kg, respectively. Procedures consisted of one arterial switch operation and two repairs of complete atrioventricular septal defects. Our static priming volume of less than 90 mL resulted in a nadir hematocrit during CPB of 27.7% (Hb 8.9 g/dL) in a patient which happened to have the lowest body weight of 2.7 kg. The two other patients had their lowest hematocrit at 31.4% (Hb 10.2 g/dL). The three children could be treated without any kind of transfusion of blood which had left the circulation or its extensions, in accordance with the parents' wishes, and enjoy favorable outcomes without transfusion of blood products during their entire hospital stay.
Surgeons face a special challenge in treating Jehovah's Witnesses who refuse blood transfusion.
To present our surgical experience with this group of patients operated on in our department.
A retrospective study of 16 unselected Jehovah's Witnesses patients was conducted between October 2004 and February 2012. We analysed gender, age, haemogram before and after surgery, types of surgery, postoperative complications and the need for blood transfusion, and/or other drugs stimulating erythrogenesis.
Eighty-one percent of patients were women; the average age of all patients was 57.3 years. Mean haemoglobin level, preoperative, postoperative, and on the day of discharge from hospital, was 12.5 g/dl, 9.7 g/dl, and 9.29 g/dl, respectively. Over the same time period, mean red blood cell count was 4.53 mln/µl, 3.58 mln/µl, and 3.37 mln/µl, respectively. Two out of 16 patients agreed to have blood transfusion. Drugs used for erythropoiesis stimulation included rEPO, ferrum, and folic acid. No surgical death was noted.
We found that abdominal surgery was safe in our small group of Jehovah's Witness patients. However, all Jehovah's Witness patients should be fully informed about the type of procedure and possible consequences of blood transfusion refusal. Two of our patients agreed to blood transfusion in the face of risk of death.
This work studies the effect of packing cracked seasoned olives with NaCl, KCl, and CaCl(2) mixture brines on their mineral nutrients and sensory attributes, using RSM methodology. The Na, K, Ca, and residual natural Mn contents in flesh as well as saltiness, bitterness and fibrousness were significantly related to the initial concentrations of salts in the packing solution. This new process led to table olives with a significantly lower sodium content (about 31%) than the traditional product but fortified in K and Ca. High levels of Na and Ca in the flesh led to high scores of acidity and saltiness (the first descriptor) and bitterness (the second) while the K content was unrelated to any sensory descriptor. The new presentations using moderate proportions of alternative salts will therefore have improved nutritional value and healthier characteristics but only a slightly modified sensory profile.
