Hemodilution and induced hypotension for insertion of a Harrington rod in a Jehovah's Witness patient.
The case of a 28-year-old Jehovah's Witness illustrates the feasibility of using a combined technique of induced hypotension and hemodilution to minimize the surgical loss of red blood cells during the insertion of a Harrington rod. A Swan-Ganz catheter with thermister tip was inserted to measure pulmonary arterial pressure, pulmonary arterial wedge pressure and cardiac output. Other intraoperative monitoring included continuous arterial pressure, electrocardiography, oropharyngeal temperature, esophageal stethoscope, arm-cuff blood pressure and urinary output from an indwelling Foley catheter. A total of 10 L of crystalloid was infused over a 2 1/2-hour period while hypotension was induced by intravenous nitroprusside and enflurane anesthesia. Hematocrit was diluted from 46% to 26% intraoperatively with an estimated surgical blood loss of 2,740 ml. The 24-hour postoperative hematocrit was 30% and recovery was uneventful. This method may be useful in any orthopedic procedure in which heavy blood loss is anticipated and the patient refuses transfusion of blood or blood products. However, the patient must be in good health and have an uncompromised cardiopulmonary system.
D000328:Adult; D000768:Anesthesia, General; D001794:Blood Pressure; D002302:Cardiac Output; D002835:Christianity; D004562:Electrocardiography; D004737:Enflurane / Q000008:administration & dosage; D006438:Hemodilution; D006801:Humans; D007023:Hypotension, Controlled; D007275:Injections, Intravenous; D008297:Male; D009599:Nitroprusside / Q000008:administration & dosage; D009983:Orthopedic Equipment; D012068:Religion and Medicine; D012600:Scoliosis / Q000601:surgery*; D014554:Urination
D009599:Nitroprusside; D004737:Enflurane