Effects of profound hemodilution on small-intestinal wound healing in rabbits.

BACKGROUND: Wound healing is influenced by tissue oxygen tension and blood perfusion, but not by moderate anemia or hemodilution. The effect of perioperative profound hemodilution on small-intestinal wound healing remains unclear. METHODS: We performed jejunectomy followed by end-to-end anastomosis in rabbits subjected to a variety of perioperative hemodilutions: HD((HES)), hemodiluted with hydroxyethylstarch; HD((P+HES)), hemodiluted with autologous plasma and hydroxyethylstarch; HD((HES))/R, hemodiluted with hydroxyethylstarch and retransfused afterward. Intraoperative hemoglobin levels were 5 g 100 ml(-1). On Postoperative Day 5, the tensile strength (TS) of the anastomosis was measured and histological specimen was obtained. The time courses of hemoglobin, serum albumin (Alb), plasma fibrinogen (Fbg), and plasma activity of factor XIII (F XIII) were measured. RESULTS: TS in HD((HES))/R (236.0 +/- 52.2 gf) was similar to that in control (266.5 +/- 41.6 gf); however, TS in HD((HES)) (179.8 +/- 17.9 gf) and HD((P+HES)) (165.5 +/- 14.7 gf) decreased significantly. The histological findings in HD((HES))/R were similar to those of control, whereas they demonstrated a delayed healing process in HD((HES)) and HD((P+HES)). Hemoglobin levels were still lower on Postoperative Day 5 in HD((HES)) and HD((P+HES)), but increased to 10.0 g 100 ml(-1) after retransfusion in HD((HES))/R. Hemodilution caused significant decreases in Alb, Fbg, and F XIII, but the values after retransfusion in HD((HES))/R were similar to postoperative values in HD((P+HES)). CONCLUSION: Intraoperative profound hemodilution does not interfere with small-intestinal wound healing as long as postoperative hemoglobin levels were maintained above 10 g 100 ml(-1). Postoperative levels of other plasma constituents may not influence wound healing.

[Minimizing of the blood preparation for elective surgery by maximum surgical blood order schedule as well as type and screen--two year's experience in Nagahama City Hospital].

To make the most of the blood products, we have introduced maximum surgical blood order schedule (MSBOS) as well as Type and Screen (T&S) into Nagahama City Hospital. As the hospital dose not have blood transfusion service unit, we, anesthesiologists set up MSBOS and the procedure of blood preparations for elective surgery. The results of two year's experience demonstrate that there was no trouble by reducing the blood preparation. The cross-match to transfusion ratio (C/T ratio) in surgical procedures and that of red cell products in our hospital have decreased, the effective use of red cell products has been promoted, and the outdating of the blood product has been reduced.