[General anaesthesia for orthopaedic pediatric surgery]. / Esperienze di anestesia generale in ambito ortopedico pediatrico.

When there are no precise indications or contraindications, the choice between general anaesthesia and locoregional anaesthesia is not clear-cut, especially in paediatrics where there are not enough prospective studies about the safety and main complications with the two techniques. This study aims at providing some clarification concerning this problem by outlining the practice of anaesthetics in the Children's Orthopaedic Ward of Rizzoli Orthopaedic Institute which, for logistical reasons and based on past experience, was carried out by the exclusive use of general anaesthesia. The organizational aspects of pre- and post-operative management of the patients are described. In addition, the data of 836 general anaesthetics carried out in the year 2000 were recorded prospectively on a daily basis. The data included the characteristics of the patient, type of surgery, anaesthesiological methods, and intra- and postoperative complications (first 24 hours). No major complications occurred. There was a small incidence of minor complications (13,3%), which all resolved without sequelae. In the group of younger children, where the lowest number of adverse events were recorded (9,7%), halothane was prevalently used, analgesic opiates were excluded, and breathing was maintained spontaneously. The authors deem the results satisfactory with regards to safety and morbidity, and recommend that anaesthetists use the anaesthesiological methods with which they are more experienced and that are most compatible with the logistical and organisational conditions in which they must work.

Methods of blood saving in revision surgery of the hip.

The blood saving protocol, which is the product of 15 years of experience, has gradually been improved, until the current form has been achieved, which includes predeposit, acute intentional isovolemic hemodilution, controlled hypotension, intraoperative blood recovery, postoperative monitoring and blood recovery, external compressive elastic dressing. The acceptance of values for hemoglobin which may even be < 8 g/dl during the late postoperative period, as long as this is well-tolerated by patients, has allowed us to drastically reduce the use of homologous transfusions. Over the last 2 years, out of 59 autotransfused patients submitted to revision surgery of the hip, only 9 (equal to 15%) required homologous transfusion. An analysis of the data shows that the use of homologous blood is associated with the presence of ischemic cardiopathy (p < 0.001) and with a predeposit which is less than 4 units of blood (packed red blood cell+fresh frozen plasma) (p = 0.05).

Autotransfusion: 15 years experience at Rizzoli Orthopaedic Institute.

The program of blood saving, result of 15 years of experience, includes predeposit (1977) hemodilution (1979) intra (1984) and postoperative (1985) salvage, careful intra and postoperative bleeding control, use of homologous transfusion only in case of intolerated anaemia even for 7-8g/dl Hb values. The use of autologous compared to homologous transfusion passed from 19% in 1984 to 62% in 1992. In 1992 in the surgical division of the 1st Anaesthesia and Intensive Care unit, 414 patients underwent prosthetic hip and knee surgery, 8% of these patients were homologously transfused.