TY  - CHAP
M1  - Book, Section
TI  - Chapter 16. Anesthetic Considerations for the Patient with Anemia and Coagulation Disorders
A1  - Klick, John C.
A1  - Avery, Edwin G.
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
PY  - 2012
T2  - Anesthesiology, 2e
AB  - Anemia  is  common  in  perioperative  patients.Hemoglobin  (Hb)  concentration  or  hematocrit  (HCT)  level  can  be  used  to  rapidly  assess  the  severity  of  anemia.Treatment  of  anemia  should  be  based  on  the  physiology  and  etiology  of  anemia.  Maintenance  and  restoration  of  normovolemia  and  cardiac  output  (CO)  are  necessary  but  insufficient  aims  in  treating  anemia.Tachycardia  and  hypotension  are  important  clinical  signs  of  hypovolemia  and  anemia,  but  compensatory  increases  in  heart  rate  and  CO  may  be  impeded  by  an  insufficient  cardiac  reserve  or  anesthetic-induced  sympathectomy.Consideration  of  the  physiologic  signs  and  laboratory  evidence  for  inadequate  tissue  oxygen  delivery  is  mandatory  before  making  a  decision  to  transfuse  red  blood  cells  (RBCs).Evidence-based  outcomes  supporting  a  specific  transfusion  trigger  level  of  Hb  or  HCT  do  not  yet  exist  for  perioperative  patients;  however,  the  limited  present  information  suggests  that  Hb  levels  as  low  as  7  to  8  g/dL  may  be  as  safe  as  higher  levels  of  Hb  in  cardiac  surgical  and  critically  ill  patients  without  clinical  evidence  of  ischemia.  Further  clinical  investigations  are  needed  to  guide  transfusion  decisions  in  critically  ill  patients.Alternatives  to  transfusion  of  allogeneic  RBCs  are  available  and  should  be  integrated  into  a  blood-conservation  strategy  for  selected  surgical  patients.Goals  of  the  perioperative  management  of  patients  with  sickle  cell  disease  are  focused  on  clinical  measures  to  avoid  precipitating  a  vaso-occlusive  crisis  and  include  avoiding  hypoxia,  hypothermia,  and  dehydration.Implementation  of  standard  or  exchange  transfusions  for  sickle  cell  patients  with  the  goal  of  reducing  Hb  S  concentration  to  less  than  30%  to  40%  can  be  helpful  to  reduce  the  incidence  of  a  perioperative  vaso-occlusive  crisis.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56625086
ER  -