Background and objective The efficiency of intraoperative autotransfusion in scoliosis surgery is poorly known but needs to be evaluated, not least because of the large blood losses in these patients. This is a retrospective analysis of transfusion requirements of 43 such patients.

Methods Records from 43 patients were studied. During surgery, the shed blood was salvaged and washed in an autotransfusion device (AT1000 Autotransfusion Unit®) and a suspension of red cells was reinfused.

Results Fifty-eight per cent of the intraoperative blood loss was salvaged. The total blood loss during the patients' hospital stay was calculated from the haemoglobin balance; 24% of this loss was salvaged by the device. Moreover, 36 of the patients needed allogeneic blood transfusion.

Conclusion The efficiency of the autotransfusion device was relatively low in relation to the total extravasation, mainly because the postoperative blood loss is substantial.

Background: Despite the growing medical and public interest in reducing exposure to allogeneic blood, little is known about the use of alternatives to allogeneic transfusion. This study was conducted to determine the availability of these technologies in Canadian hospitals and was undertaken under the auspices of the International Study of Peri-Operative Transfusion (ISPOT), a 10-country study of the effectiveness of, attitudes toward, and practices related to the use of alternatives to allogeneic transfusion.

Methods: A cross-sectional national mail survey of Canadian hospitals with greater than 50 medical/surgical beds. Chiefs of anesthesia, surgery, and the divisions of cardiac, orthopedic, vascular, and urology were initially mailed a brief postcard asking which of seven technologies were used in their center. This was then followed up with a one-page questionnaire asking how frequently the technologies were used, their thoughts on the appropriateness of the use of the technologies, barriers to their greater use, and reasons for nonuse of the technologies.

Results: Response rates to the postcard survey ranged from 70%–98%, depending on the technology and type of surgery, and ranged from 27%–53% for the follow-up questionnaire. All technologies were used most frequently in cardiac surgery. Aprotinin, tranexamic acid, aminocaproic acid, desmopressin, and cell salvage were reported used in over 70% of cardiac surgery centers. Of these, tranexamic acid and cell salvage were the only ones used routinely in some centers. Acute normovolemic hemodilution and erythropoietin were used in 45% and 20% of cardiac centers, respectively. The drugs were used in less than 15% of orthopedic, vascular, and urologic divisions, with the exception of desmopressin in urologic and vascular surgery and aminocaproic acid in urologic surgery. The techniques of cell salvage and acute normovolemic hemodilution were used in 30%–45% of these divisions, with the exception of cell salvage, which was used in less than 15% of urology units. In more than 60% of cases, the technologies were considered to be used “about right,” although an important minority felt that they were underused.

Conclusions: In general, alternatives to perioperative allogeneic transfusion were rarely used except in cardiac surgery.

The efficacy of an integrated autotransfusion regimen, including pre-donation and perioperative salvage of autologous blood, was prospectively evaluated in 2884 patients undergoing total hip (n=2016) or knee arthroplasty (n = 480), and hip revision (n = 388) with either balanced general, regional, or integrated epidural/general anaesthesia. Allogenic concentrated red blood cells were transfused in the presence of symptomatic anaemia or when haemoglobin concentration was < 6gdL−1 (10gdL−1 in patients affected by cerebrovascular or coronary artery disease) after all salvaged and pre-donated autologous blood had been transfused. A total of 278 patients (9.6%) received allogenic blood. Risk factors for allogenic blood transfusion were: preoperative haemoglobin concentration < 10gdL−1 (after autologous blood pre-donations) (Odds ratio: 8.7; 95% CI: 6.5–16.8; P=0.004), hip revision versus hip or knee arthroplasty (Odds ratio: 5.8; 95% CI: 3.9–8.5; P=0.0001) and inability in obtaining the number of predonations required by the Maximum Surgery Blood Order on Schedule (Odds ratio: 3.4; 95% CI: 2.7–4.1; P=0.0001). The incidence of perioperative complications, including wound infection and haematoma, as well as myocardial ischaemia, respiratory failure and thromboembolic complications, was higher in those patients requiring allogenic blood transfusion (29.8%) than that observed in patients receiving only autologous blood (6.6%) (P=0.0005); while the mean time duration from surgical procedure to patient discharge from the orthopaedic ward was shorter in those patients not receiving allogenic blood transfusion (12 days; 25–75th percentiles: 8–14 days) than in those patients who required perioperative transfusion with allogenic blood (15 days; 25–75th percentiles: 10–17 days) (P=0.0005). In conclusion, this prospective study highlighted the clinical relevance of applying an extensive and integrated autotransfusion regimen in order to reduce allogenic blood transfusion and associated complications in patients undergoing major joint replacement.

A prospective survey was conducted among an aesthesiologists to determine their criteria for excluding a patient from autologous blood donation prior to total hip prosthesis. Information on patients operated on during a 5-week period was obtained using a questionnaire, consisting of a set of possible responses to simple questions, matched with some parametric values. Sixty-eight of the 99 patients included in the survey underwent surgery without donation. Age was the main cause for exclusion (34%). The age of patients excluded because of their age alone was 75 ± 11 years (standard deviation). The age of patients excluded from donation and who did not subsequently receive homologous blood was comparable with that of patients not autotransfused but who received homologous blood (68 ± 4 vs. 69 ± 6 years, respectively). Post-operative haemoglobin concentrations were similar whether transfusion was performed or not, and regardless of the origin of blood given. Since age is no longer taken into consideration at the time of transfusion, it is likely that exclusion of a patient from autologous blood donation because of age is an arbitrary choice.

Loss of bony integrity of the temporomandibular joint may result in prolapse of the joint capsule into the external auditory canal. This in turn gives rise to arthralgia, trismus and earache and a risk of septic arthritis.

We describe a technique of repair which is simple, uses autologous tissue and has an acceptable cosmetic and functional result.

A new technique for the treatment of severe epistaxis associated with hereditary haemorrhagic telangiectasia is described. The nasal septum and inferior turbinates, surgically denuded of respiratory epithelium, were grafted using autografts of cultured epithelial sheets derived from buccal epithelium. All patients upon whom this technique has been used have shown considerable lessening in the frequency and severity of their epistaxes although two patients received grafts on two occasions, in each case approximately three months apart. It is postulated that a nasal lining of stratified squamous epithelium is likely to be more resistant to trauma than the normal respiratory type, and this is supported by the observation that bleeds very seldom occur from the oral cavity in this syndrome.