Perioperative blood management strategies for patients undergoing total knee replacement:Where do we stand now?  

作　　者：Tzatzairis Themistoklis Vogiatzaki Theodosia Kazakos Konstantinos Drosos I Georgios 

机构地区：[1]Department of Orthopaedic Surgery,Medical School,Democritus University of Thrace,University General Hospital of Alexandroupolis [2]Department of Anaesthesia,Medical School,Democritus University of Thrace,University General Hospital of Alexandroupolis

出　　处：《World Journal of Orthopedics》2017年第6期441-454,共14页世界骨科杂志（英文版）

摘　　要：Total knee replacement(TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions(ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.Total knee replacement(TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions(ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

关 键 词：TOTAL KNEE replacement TRANSFUSION TOTAL KNEE arthroplasty BLOOD loss Autologous BLOOD donation BLOOD management PERIOPERATIVE Tranexamic acid Tourniquet HAEMODILUTION Anaemia TRANSFUSION protocol 

分 类 号：R687.4[医药卫生—骨科学]