Intraoperative Cell salvage(ICS)

Intraoperative cell salvage (ICS) is a method of scavenging blood from the operative field, allowing it to be re-infused back into the patient. The technique involves aspirating blood lost within the surgical field into a collection reservoir. Blood is mixed with an anticoagulant solution containing either heparin or citrate to prevent clotting.

Indications for intraoperative cell salvage (ICS)

ICS systems may be used in elective and/or emergency surgical procedures where the surgical field is not contaminated by faecal or infective matter and where no other contraindications exist.
Patient selection for ICS is at the discretion of the surgeon and anaesthetist caring for the patient based on an individual risk benefit assessment.

ICS indications:

Patients undergoing elective or emergency surgical procedures where the anticipated blood loss is greater than 200 ml and exceeds 20% of the patient’s estimated blood volume
The main indications in the paediatric population are craniosynostosis surgery, scoliosis surgery and cardiac surgery.
Patients undergoing elective or emergency surgical procedures who have low preoperative haemoglobin levels, where the anticipated blood loss is greater than 200 ml, and exceeds the loss required to trigger a blood transfusion
Patients who have rare blood groups or multiple antibodies
Patients who, for moral, religious or other reasons, are unwilling to receive allogeneic blood and have given their consent to receiving autologous blood collected using ICS .

ICS contraindications

ICS should not be used when the surgical field is contaminated by bowel contents .
In the following situations ICS should usually be avoided:

Sickle cell trait and disease
Malignant disease
Heparin induced thrombocytopenia or allergy to heparin

Comments

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

sedationstation

Search This Blog