title: Strategies to reduce blood loss during posterior spinal fusion for neuromuscular scoliosis: a review of current techniques and experience with a unique bipolar electrocautery device.
abstract: In this chapter, we review current techniques employed to decrease blood loss and describe the effective use of a unique bipolar electrocautery device in a patient with neuromuscular scoliosis undergoing posterior spinal fusion (PSF). The reduction of blood loss and subsequent elimination of allogeneic blood transfusion is a desired outcome in all surgeries and is a major concern during PSF. In the child or adolescent with neuromuscular scoliosis, this becomes a greater concern due to a variety of factors such as the inability of the musculature to compress blood vessels, extensive surgical exposure, and the duration of the operation. A multitude of pharmacological, anesthetic, and surgical techniques-including preoperative autologous blood donation and human recombinant erythropoietin, intraoperative blood salvage techniques, and topical and systemic hemostatic agents-are employed to reduce the need for transfusion. Many of these techniques carry their own risks and, thus far, a systematic approach has not been established to decrease the need for transfusion. In the continued pursuit of reducing intraoperative blood loss, other surgical techniques must be developed.
authors.affiliation: Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA.
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.forename: Andrew
authors.initials: A
authors.lastname: Torre-Healy
authors.forename: JahanGir
authors.initials: J
authors.lastname: Asghar
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Herlich
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
mesh_terms: D004564:Electrocoagulation / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome