RESUMO

The preoperative clinical and laboratory evaluations of the patient is an essential step to ensure the safety and success of any surgical procedure. This assessment aims to identify any underlying medical conditions and risk factors and determine suitability for surgery. With this step, the medical team can adapt the care plan to meet each patient's specific needs, increasing the chances of a successful procedure. Good clinical assessment and comprehensive laboratory testing, when integrated into a Patient Blood Management approach, are invaluable in promoting safety of care, reducing transfusion risks, improving surgical outcomes, and optimizing resource utilization. This approach not only elevates the quality of care, but is also aligned with evidence-based practice and patient-centered principles, making it an essential component of the perioperative process.

RESUMO

Managing coagulation disorders and potential bleeding risks, especially in the context of anticoagulant medications, is of immense value both clinically and prior to surgery. Coagulation disorders can lead to bleeding complications, affecting patient safety and surgical outcomes. The use of Patient Blood Management protocols offers a comprehensive, evidence-based approach that effectively addresses these challenges. The problem is to find a delicate balance between preventing thromboembolic events (blood clots) and reducing the risk of bleeding. Anticoagulant medications, although crucial to preventing clot formation, can increase the potential for bleeding during surgical procedures. Patient blood management protocols aim to optimize patient outcomes by minimizing blood loss and unnecessary transfusions.

RESUMO

Abstract The preoperative clinical and laboratory evaluations of the patient is an essential step to ensure the safety and success of any surgical procedure. This assessment aims to identify any underlying medical conditions and risk factors and determine suitability for surgery. With this step, the medical team can adapt the care plan to meet each patient's specific needs, increasing the chances of a successful procedure. Good clinical assessment and comprehensive laboratory testing, when integrated into a Patient Blood Management approach, are invaluable in promoting safety of care, reducing transfusion risks, improving surgical outcomes, and optimizing resource utilization. This approach not only elevates the quality of care, but is also aligned with evidence-based practice and patient-centered principles, making it an essential component of the perioperative process.

Assuntos

RESUMO

Abstract Managing coagulation disorders and potential bleeding risks, especially in the context of anticoagulant medications, is of immense value both clinically and prior to surgery. Coagulation disorders can lead to bleeding complications, affecting patient safety and surgical outcomes. The use of Patient Blood Management protocols offers a comprehensive, evidence-based approach that effectively addresses these challenges. The problem is to find a delicate balance between preventing thromboembolic events (blood clots) and reducing the risk of bleeding. Anticoagulant medications, although crucial to preventing clot formation, can increase the potential for bleeding during surgical procedures. Patient blood management protocols aim to optimize patient outcomes by minimizing blood loss and unnecessary transfusions.

Assuntos

RESUMO

OBJECTIVE: The objective of this study was to evaluate the biochemical and blood gas alterations of whole blood of buffaloes that was stored in citrate-phosphate-dextrose with adenine (CPDA-1) and CPD/SAG-M blood bags for 42 days. DESIGN: Prospective study. INTERVENTIONS: Ten male buffaloes were used in this study. A total volume of 900 mL of blood was collected from each buffalo so that 450 mL was stored in CPDA-1 and 450 mL was stored in CPD/SAG-M bags at 2-6°C for 42 days. The stored blood was evaluated at 7 time points (D): D0 (immediately after blood collection) and 7 (D7), 14 (D14), 21 (D21), 28 (D28), 35 (D35), and 42 (D42) days after collection. Blood gas, biochemical, and microbiological parameters were monitored. MEASUREMENTS AND MAIN RESULTS: The overall blood pH decreased from 6.997 ± 0.05 at D0 to 6.784 ± 0.09 at D42, differing from baseline from D14 onward (P < 0.05). There were increases in partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), lactate, and potassium (K) and decreases in the concentrations of sodium, bicarbonate, glucose, and pH (P < 0.05) during storage in both bags but no alterations in total protein concentration. Most of the variables were consistently similar between the 2 types of blood bags (P > 0.05) evaluated, with the exception of pCO2 , HCO3, cholesterol, and total protein, which had higher values in the CPDA-1 bag (P < 0.05). The K, pO2 , and lactate had the highest alterations during storage, with increases from baseline to D42 of 563%, 317%, and 169%, respectively. CONCLUSION: In general, no significant changes of clinical importance were observed after storage of whole blood samples from buffaloes for 42 days in the 2 types of blood bags that are indicated for use with this species.

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RESUMO

Las transfusiones sanguíneas alogénicas han tenido un rol central en el desarrollo de la medicina, principalmente como terapia de soporte en pacientes críticos, cirugía mayor, trauma y trastornos hematopoyéticos. Sin embargo, su utilización no está exenta de importantes efectos adversos y de altos costos asociados. Además, los productos sanguíneos son un recurso limitado que no debe ser desperdiciado. Por otro lado, la cirugía en pacientes que rehúsan la utilización de hemoderivados ha mostrado igual o mejores resultados que los pacientes que aceptan transfusiones. Esto ha llevado a buscar un manejo apropiado de la sangre en todos nuestros pacientes, evitando los riesgos y costos innecesarios de las transfusiones, pero permitiéndolos cuando se cree que los beneficios serán mayores que los riesgos. En este trabajo se presentan 3 pilares esenciales. El primero es el diagnóstico y manejo apropiado de la anemia preoperatoria, disminuyendo los riesgos perioperatorios, ya que la anemia por sí sola es un factor de morbimortalidad. El segundo pilar está constituido por diversas técnicas, que están disponibles en la actualidad, para minimizar el sangrado perioperatorio. Finalmente, el tercer pilar es mejorar la tolerancia a la anemia. El uso en conjunto de diversas técnicas descritas en este trabajo ha mostrado ser efectivo en disminuir el sangrado perioperatorio, la necesidad de transfusiones alogénicas y las unidades de sangre utilizadas, lo cual podría permitir mejores resultados clínicos en nuestros pacientes.

Allogeneic blood transfusions have played a central role in the development of medicine, mainly as a support therapy in critically ill patients, major surgery, trauma and hematopoietic disorders. However, their use is not without significant adverse effects and associated high costs. Moreover, blood products are a limited resource that should not be wasted. Furthermore, surgery in patients who refuse the use of blood products has shown equal or better results than patients who accept transfusions. This has led to seek an appropriate blood management in all our patients, avoiding unnecessary costs and risks of transfusions, but allowing them when they believe the benefits outweigh the risks. In this paper three essential pillars are presented. The first is the appropriate diagnosis and management of pre-operative anaemia decreasing perioperative risk, since anaemia itself is a factor of morbidity and mortality. The second pillar is formed by various techniques that are available today to minimize bleeding perioperative. Finally, the third pillar is to improve tolerance to anaemia. The joint use of various techniques described in this paper has proven effective in decreasing perioperative bleeding, the need for allogeneic transfusions and blood units used, which may allow better clinical outcomes in our patients.

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RESUMO

O presente trabalho teve como objetivo avaliar e comparar as alterações bioquímicas e hemogasométricas do sangue total canino armazenado em bolsas CPDA-1 e CPD/SAG-M. Foram utilizados 14 cães machos, adultos e saudáveis, distribuídos em dois grupos com sete animais cada, dos quais foi obtido sangue para o estudo. No primeiro grupo (G1), o sangue foi armazenado em bolsas CPDA-1 e, no segundo grupo (G2), o sangue foi armazenado em bolsas CPD/SAG-M. As amostras foram analisadas para: potássio, sódio, glicose, proteína plasmática total, DPG, pH sangüíneo, pO2 , pCO2 e bicarbonato. Os momentos estabelecidos para as análises laboratoriais foram: D0: imediatamente após a coleta do sangue dos animais; D7: sete dias após a coleta; D14: quatorze dias após a coleta; D21: vinte e um dias após a coleta; D31: trinta e um dias após a coleta; D41: quarenta e um dias após coleta. A análise dos resultados permitiu concluir que a bolsa CPD/SAG-M apresentou melhor desempenho quando comparada à CPDA-1 após 41 dias de estocagem. O DPG, mesmo com pH inferior a sete, continua sendo produzido por, pelo menos, uma semana após a estocagem do sangue na bolsa.(AU)

The present study was aimed at evaluating and comparing the biochemical and haemogasometrics alterations of the total blood of dogs stored in bags CPDA-1 and CPD/SAG-M. 14 male's dogs, adult and healthful dogs, were divided in two groups, which one blood was removed for the study. The blood of the first group (G1) was stored in bag CPDA-1 and that of the second group (G2) in bag CPD/SAG-M. The samples were analyzed for: potassium, sodium, glucose, total plasmatic protein, DPG, pH, pO2 , pCO2 , and bicarbonate. The moments for the laboratory analyses were established: D0: immediately after the collection of blood; D7: seven days after the collection; D14: fourteen days after the collection; D21: twenty and one days after the collection; D31: thirty and one days after the collection; D41: forty one days after collect. The evaluation of the results allowed including that: the bag CPD/SAG-M presented advantage when compared with the CPDA-1 after 41 days of stored. The DPG, even with pH lower then 7, continues being produced for, at least, one week after the stocking of the blood in the bag.(AU)

Assuntos

RESUMO

O presente trabalho teve como objetivo avaliar e comparar as alterações bioquímicas e hemogasométricas do sangue total canino armazenado em bolsas CPDA-1 e CPD/SAG-M. Foram utilizados 14 cães machos, adultos e saudáveis, distribuídos em dois grupos com sete animais cada, dos quais foi obtido sangue para o estudo. No primeiro grupo (G1), o sangue foi armazenado em bolsas CPDA-1 e, no segundo grupo (G2), o sangue foi armazenado em bolsas CPD/SAG-M. As amostras foram analisadas para: potássio, sódio, glicose, proteína plasmática total, DPG, pH sangüíneo, pO2 , pCO2 e bicarbonato. Os momentos estabelecidos para as análises laboratoriais foram: D0: imediatamente após a coleta do sangue dos animais; D7: sete dias após a coleta; D14: quatorze dias após a coleta; D21: vinte e um dias após a coleta; D31: trinta e um dias após a coleta; D41: quarenta e um dias após coleta. A análise dos resultados permitiu concluir que a bolsa CPD/SAG-M apresentou melhor desempenho quando comparada à CPDA-1 após 41 dias de estocagem. O DPG, mesmo com pH inferior a sete, continua sendo produzido por, pelo menos, uma semana após a estocagem do sangue na bolsa.

The present study was aimed at evaluating and comparing the biochemical and haemogasometrics alterations of the total blood of dogs stored in bags CPDA-1 and CPD/SAG-M. 14 male's dogs, adult and healthful dogs, were divided in two groups, which one blood was removed for the study. The blood of the first group (G1) was stored in bag CPDA-1 and that of the second group (G2) in bag CPD/SAG-M. The samples were analyzed for: potassium, sodium, glucose, total plasmatic protein, DPG, pH, pO2 , pCO2 , and bicarbonate. The moments for the laboratory analyses were established: D0: immediately after the collection of blood; D7: seven days after the collection; D14: fourteen days after the collection; D21: twenty and one days after the collection; D31: thirty and one days after the collection; D41: forty one days after collect. The evaluation of the results allowed including that: the bag CPD/SAG-M presented advantage when compared with the CPDA-1 after 41 days of stored. The DPG, even with pH lower then 7, continues being produced for, at least, one week after the stocking of the blood in the bag.

Assuntos