Bloodless (liver) surgery? The anesthetist's view.
OBJECTIVE
An increasing amount of literature concerning blood conservation, restrictive transfusion strategies, pharmacological manipulation of the hemostatic and fibrinolytic systems, minimal invasive surgery, local hemostatic agents and guidelines for blood transfusion, is being published each year. Is 'bloodless (liver) surgery' or rather minimization of perioperative blood loss and transfusion requirement necessary?


METHODS
To answer this question, we studied key articles and checked cross-references with the support of PubMed and the Cochrane Database of systematic reviews.


RESULTS
At present there is still a need to reduce the use of blood. Pre-donation, set of transfusion triggers, (non-)pharmacological approaches to decrease surgical blood loss, hemodilution techniques, peri- and postoperative cell salvage and postoperative re-transfusion can contribute to the success of a bloodless (liver) surgery program.


CONCLUSIONS
We conclude that a multidisciplinary effort has to be made through the entire chain, from the outpatient clinic through discharge from the hospital, with the utmost exertion of all team members in which surgeons play a key role in the adaptation of a bloodless (liver) surgery program to the specific needs of patients.
Hofland
Jan
J
Departments of Anesthesiology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
Henny
C Pieter
CP
D000758:Anesthesia / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006438:Hemodilution / Q000379:methods; D006488:Hemostasis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D019990:Perioperative Care / Q000379:methods / Q000592:standards; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D039781:PubMed; D013514:Surgical Procedures, Operative; D065227:Transfusion Reaction
D007552:Isotonic Solutions