Prescription and carrying out of autologous blood transfusion in a university hospital during a whole year (1992) were investigated. 554 patients were involved. 88% of them gave at least one blood unit. Three surgical groups are specified: cardiac surgery with bypass (95 patients), orthopaedic procedures with knee or hip replacement or spine surgery (276 patients) and other types of surgery (117 patients). Prescriptions of blood donation before cardiac surgery were not carried out (by the transfusion centre) twice more often than in the other groups. This is why autologous blood taking is now effected in the anaesthetic unit. 88.9% (n = 434) of all patients did not receive homologous blood (90% in the orthopaedic group, 84% in the cardiac group). 25% of the collected units were not transfused. This figure is only 8% for the cardiac patients. An efficiency index is suggested taking in account the transfusion of autologous blood units and the need of homologous transfusion: % autologous used units x % procedures realized without homologous blood. The good rate to achieve could be 70%. In aorto-coronary bypass surgery when no autologous blood was collected preoperatively, 57.5% patients received homologous blood vs 16% when at least one unit was predeposited. A short review of literature shows an increasing place of predeposited autotransfusion, with some limits in orthopaedic surgery where a combination of autologous blood donation and other erythrocytes saving methods appears to give the best results. Erythropoietin, critical haemoglobine concentration threshold, autologous transfusion in cancer patients still need further studies.

Objectives: To assess after cardiopulmonary bypass (CPB) the role of paf-acether (paf), a phospholipid mediator whose injection in animal mimics the hemodynamics observed after CPB.Design: Prospective double-blind randomized study.Setting: Single institutional university hospital.Participants: 18 patients scheduled to undergo coronary artery bypass graft.Interventions: 18 patients randomly received a placebo (n = 8) or 120 mg BN52021 (n = 10), a paf-receptor antagonist injected twice just before vascular cannulation and before cross-clamp release.Measurements and Main Results: Hemodynamic measurements were performed with a pulmonary artery and a radial artery catheter before and after the first injection of BN52021 or placebo, at the end of CPB, 1, 15, and 30 minutes after protamine infusion, then 6 hours and 24 hours postoperatively. BN52021 infusion, did not affect hemodynamic parameters. After CPB, the pulmonary artery pressures, the cardiac index, and the pulmonary artery occlusion pressures were statistically the same between groups. By contrast, the pulmonary vascular resistances (1.5 +/- 0.5 IU v 4.5 +/- 0.6 IU, p < 0.05), the right ventricular systolic work index (5.33 +/- 0.91 g m m(-2) v 9.37 +/- 1.02 g m m(-2), p < 0.05) and the transpulmonary gradient (4.7 +/- 1.1 mmHg v 12.0 +/- 1.2 mmHg, p < 0.05) were lower in the BN52021 group as compared with the placebo group. After protamine infusion, these differences between groups disappeared.Conclusion: Because the inotropic and vasodilator therapy and the volume loading were the same between groups, this study suggests that pretreatment with a paf-receptor antagonist improves post-CPB pulmonary resistance. Nevertheless, this beneficial effect is transient without consequences on left ventricular function indices. (C) 1995 by W.B. Saunders Company

Deux groupes de neuf patients subissant la pose d'une prothèse aorto-bifémorale ont été étudiés. Après une prémédication par morphine (10 mg) et flunitrazépam (1 mg), un cathéter radial et une sonde de Swan-Ganz ont été mis en place. Le débit cardiaque a été mesuré par thermodilution. Les paramètres hémodynamiques ont été mesurés avant l'induction (t0), 15 min après l'intubation (t1), 10 min après l'incision (t2), 5 min avant le clampage de l'aorte (t3), pendant le clampage (t4) et quelques minutes après le déclampage. Les deux groupes ont été anesthésiés après avoir reçu 5 g · kg−1 de fentanyl. Le groupe A (propofol) a reçu 2 mg · kg−1 de propofol, le groupe B (isoflurane) 4 mg · kg−1 de thiopental. L'intubation a été facilitée par 0,1 mg · kg−1 de vécuronium. Dans le groupe A, l'anesthésie a été entretenue par propofol (100 g · kg−1 · min−1) dans le groupe A, par isoflurane (concentration alvéolaire = 0,90 vol. %) dans le groupe B. La ventilation artificielle a été menée avec un mélange d'oxygène et de N2O assurant une Fio2 de 0,40. La comparaison des deux groupes montre que la diminution de la pression artérielle moyenne à t2 et t3 est significativement plus importante avec le propofol (−16 %). Dans le groupe A, la pression systolique et la fréquence diminuent respectivement de 23 et de 19 % après l'induction (p <0,05). L'index cardiaque diminue de 20 % et les résistances systémiques ne varient pas. La réduction des pressions, de la fréquence cardiaque et de l'index cardiaque n'est pas significative pour le groupe B. Les variations hémodynamiques dues au clampage ne sont pas significatives entre les groupes ou à l'intérieur de ceux-ci. Dans le groupe A, un patient a eu un épisode de bradycardie avec hypotension et ischémie myocardique, et un patient est décédé de fibrillation ventriculaire en période postopératoire. Deux retards de réveil ont été constatés avec le propofol. Les besoins en fentanyl ont semblé plus importants avec le propofol; la dose de curare a, par contre, été identique dans les deux groupes.

Two groups of nine patients each, all undergoing surgery for aorto-bifemoral prosthesis, were studied. They were premedicated with 10 mg morphine and 1 mg flunitrazepam. A Swan-Ganz catheter was then inserted. Cardiac output was measured by thermodilution. Haemodynamic parameters were measured before induction (t0), 15 min after intubation (t1), 10 min after the start of the surgical procedure (t2), 5 min before clamping the aorta (t3), whilst the aorta was clamped (t4), and a few minutes after unclamping. Group A received 2 mg X kg-1 propofol at induction, anaesthesia being maintained with 100 micrograms X kg-1 X min-1 propofol. Group B received 4 mg X kg-1 thiopentone, followed by isoflurane at the dose of 0.9 vol. %. Both groups received 5 micrograms X kg-1 fentanyl and 0.1 mg X kg-1 vecuronium to ease intubation. Artificial respiration was carried out with a mixture of 40% oxygen and 60% nitrous oxide. The fall in blood pressure between t2 and t3 was significantly more important in the propofol group (-16%). In the same group, the systolic blood pressure and heart rate fell by 23 and 19% respectively after induction (p less than 0.05); the cardiac index fell by 20% and the systemic vascular resistances did not change. The fall in blood pressure, heart rate and cardiac index were not significant for group B. The haemodynamic changes due to clamping of the aorta were not significant between or within groups. In group A, one patient presented with bradycardia, hypotension and myocardial ischaemia, and another died of postoperative ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)