Anesthetic Precautions for Bloody and Lengthy Surgery
A) Precautions for Bloody Surgery
1-Decrease blood loss by:
➧ The surgical site elevation is 10-15°
➧ Use of tourniquet
➧ Local infiltration of epinephrine
➧ Use of topical hemostats
➧ Application of hypotensive anesthesia
➧ Controlled mechanical ventilation (decrease venous return → decrease Cardiac output and PaCO₂)
➧ Use antifibrinolytic agents: (Aprotinin, Epsilon Amino Caproic Acid, Tranexamic acid)
➧ Use desmopressin (DDAVP)
➧ Keep patient normothermic
➧ Give IV Calcium (to prevent citrate toxicity and help coagulation)
➧ Restrict diagnostic phlebotomies
➧ Avoid: (Atropine, Ketamine, Pancuronium) (increase: Heart rate, Blood pressure, Endogenous catecholamines)
2-Restore Blood loss rapidly by:
➧ Prepare type-specific, cross-matched blood
➧ Preoperative autologous blood donation
➧ Apply normovolemic hemodilution
➧ Use cell saver devices (Blood Salvage)
➧ Insert wide bore IV cannulae
➧ Use blood substitutes
➧ Use rapid infusion devices
➧ Use blood warmers
B) Precautions for Lengthy Surgery
1-Decrease Hypothermia by:
➧ Monitoring by a temperature probe
➧ Increase ambient room temp. ≥ 24° (in Adults), ≥ 26° (in Pediatrics)
➧ Cotton wrapping of the limbs and head
➧ Use a warming blanket/mattress
➧ Warm IV fluids
➧ Warm irrigating fluids
➧ Warm humidified inspired gases
➧ Use low-flow anesthesia
➧ Use blood warmers
2-DVT prophylaxis.
3-Pressure sore prophylaxis (Padding of pressure points).
4-Eye protection (Tap and Pad).
5-Invasive monitoring (CVP, IBP).
6-Avoid N₂O (causes: Bone marrow depression, Megaloblastic anemia, Agranulocytosis, Peripheral neuritis, Immune response depression).
7-Use Isoflurane (More rapid recovery).
8-Insert nasogastric tube (to avoid gastric distension).
9-Use high volume, low-pressure ETT cuff (with frequent monitoring of intracuff pressure or use intracuff saline).
10-Avoid hypovolemia (by: Monitoring, Fluid chart, IV fluids).
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