title: [Anesthetic management using auto-transfusion and hypothermia for massive bleeding].
abstract: A 51-year-old woman was scheduled for emergency enterectomy and vascular repair under general anesthesia for active bleeding from internal iliac artery caused by repeated radiotherapy for cervical cancer and subsequent hypovolemic shock. For the first two hours of operation, the blood loss exceeded 6,000 ml and the hemoglobin level decreased to a low of 3.8 g x dl(-1) despite administration of 38 units of packed red cells. Intraoperative blood salvage was used in order to minimize further loss of hemoglobin. Mild hypothermia technique was also introduced to prevent brain ischemia. Total bleeding volume was approximately 10,000 ml, and total transfused volume was 8,740 ml. No neurological deficit and no systemic infection were found during the postoperative course. Although clinical risks of cell salvage in patients undergoing surgery for malignant tumor remain controversial, we conclude intraoperative blood salvage using Cell Saver could be utilized as a life-saving means and mild hypothermia might have been efficacious for protecting the brain from ischemia in our case.
authors.affiliation: Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center Tokyo 136-0075.
authors.forename: Michi
authors.initials: M
authors.lastname: Ishizawa
authors.forename: Sonoko
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Keiko
authors.initials: K
authors.lastname: Tajima
authors.forename: Ruriko
authors.initials: R
authors.lastname: Konishi
authors.forename: Hiromasa M
authors.initials: HM
authors.lastname: Itsuhata
mesh_terms: D000768:Anesthesia, General; D001804:Blood Transfusion, Autologous / Q000379:methods*; D002545:Brain Ischemia / Q000517:prevention & control; D004630:Emergencies; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007082:Ileum / Q000601:surgery; D007083:Iliac Artery / Q000601:surgery; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D012769:Shock / Q000150:complications; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000532:radiotherapy