title: Changes in Cerebral Oxygenation during Transfusion Therapy.
abstract: This study assesses the effects of transfusion of autologous or allogeneic blood on cerebral and tissue oxygenation during spinal surgery. Packed red blood cell transfusions are indicated to improve oxygen delivery to tissues. There are limited data demonstrating changes in tissue oxygenation with blood administration. Tissue (deltoid) and cerebral oxygenation were monitored using near-infrared spectroscopy during spinal surgery in patients. As indicated, cell saver or allogeneic blood was administered. Tissue and cerebral oxygenation were recorded before and after transfusion. The study enrolled 50 patients, 33 of whom (17 males and 16 females) received allogeneic blood (n= 8) or autologous blood (n= 25). Patients ranged in age from 9 to 19 years (14.0 ± 2.3 years) and in weight from 16.8 to 122.7 kg (54.6 ± 25.7 kg). Tissue oxygenation increased from 83 ± 9 (pretransfusion) to 86 ± 7 at the end of transfusion (p= .002) and remained at the same level (86 ± 7) in the post-transfusion period. Cerebral oxygenation increased from 76 ± 8 (pretransfusion) to 84 ± 8 at the end of transfusion (p< .001) and remained at 84 ± 8 in the post-transfusion period. Changes in tissue and cerebral oxygenation were similar between cell saver and allogeneic blood and between starting hemoglobin value <8 gm/dL and starting hemoglobin ≥8 gm/dL. In conclusion, although both cerebral and tissue oxygenation increased during the administration of either allogeneic or autologous blood, the clinical impact was likely limited given the high initial tissue and cerebral oxygenation values. No differences were noted between autologous (cell saver) and allogeneic blood or based on the starting hemoglobin value.
authors.affiliation: Departments of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Mumin
authors.initials: M
authors.lastname: Hakim
authors.affiliation: Departments of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: Departments of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.; Department of Anesthesiology, The Ohio State University, Columbus, Ohio.
authors.forename: David P
authors.initials: DP
authors.lastname: Martin
authors.affiliation: Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Walter
authors.initials: W
authors.lastname: Samora
authors.affiliation: Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Allan C
authors.initials: AC
authors.lastname: Beebe
authors.affiliation: Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Klamar
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Hodge
authors.affiliation: Departments of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.; Department of Anesthesiology, The Ohio State University, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D001921:Brain / Q000378:metabolism*; D002648:Child; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D057725:Operative Blood Salvage / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: blood avoidance; blood transfusion; cell saver; cerebral oxygenation; near-infrared spectroscopy