title: Anesthetic management for ascending aorta replacement in a patient who refused autologous transfusion for religious reasons.
abstract: We report on the anesthetic management of a 69-year-old female Jehovah's Witness undergoing cardiopulmonary bypass to replace the ascending aorta; the patient refused transfusion of stored autologous or allogeneic blood products for religious reasons. The strategy involved preoperative hematopoiesis with recombinant human erythropoietin and iron, intraoperative acute normovolemic hemodilution, the use of a cell-saver system, administration of high-dose tranexamic acid, controlled hypotension, avoidance of low body temperature, simplification of the surgery, and lower blood dilution during cardiopulmonary bypass.
authors.affiliation: Department of Anesthesiology, Fukushima Medical University School of Medicine, 1 Hikari-gaoka, Fukushima 960-1295, Japan.
authors.forename: Shinju
authors.initials: S
authors.lastname: Obara
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Akatu
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Isosu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Murakawa
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D017130:Angioplasty; D000925:Anticoagulants / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001011:Aorta / Q000601:surgery*; D001804:Blood Transfusion, Autologous; D001810:Blood Volume; D002315:Cardiopulmonary Bypass; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006410:Hematopoiesis / Q000187:drug effects; D006438:Hemodilution; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007023:Hypotension, Controlled; D033221:Jehovah's Witnesses; D011994:Recombinant Proteins; D014148:Tranexamic Acid / Q000627:therapeutic use; D016312:Treatment Refusal
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D014148:Tranexamic Acid; D006493:Heparin
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