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94° Congresso Nazionale SIOT – Milano, 7-11 Novembre 2009 
La risorsa sangue in ortopedia : 
valutazioni anestesiologiche ...
Sostenere una ossigenazione adeguata 
alle esigenze degli organi vitali
DO2 deve essere sempre adeguato a VO2 
EEssiiggeennzzee ffuunnzziioonnaallii 
Trasporto di O2 
DO2 
Consumo di O2 
VO2 
Me...
Paziente chirurgico 
rischio di anemizzazione 
Anemia preoperatoria 
legata alla patologia 
propria dell’intervento 
Preve...
…….. between 60% and 70% of all red blood cell units 
are transfused in the surgical setting 
(Cook 1991; Lenfant 1992; Su...
……… and more recently, that half of all the blood transfused in 
the United Kingdom is to surgical patients (Regan 2002)
Transfus Med. 2009 Sep 3. 
The EASTR Study: indications for transfusion and estimates of transfusion 
recipient numbers in...
Total hip arthroplasty 
Dept of Anaesthesia, 
Cappagh Hospital, 
Dublin 
Ann Chir Gynaecol. 
1996 
Transfusion. 
2003 
J B...
SSTTUUDDIIOO SSAANNGGUUIISS 
revisione della pratica trasfusionale 
in 43 Ospedali di 10 Paesi UE 
- Emicolectomia 
- BPAC...
LLaa %% ddii ttrraassffuussiioonnii nnoonn ppuuòò eesssseerree ll’’uunniiccoo iinnddiiccaattoorree 
ddeellllaa ggiiuusstta...
Strategie per la riduzione di emotrasfusioni 
Correzione deficit ddii ccooaagguullaazziioonnee 
TTeeccnniicchhee cchhiirru...
Practice Guidelines for blood component therapy: 
a report by the American Society of Anesthesiologists 
Task Force on Blo...
Transfusion Trigger : 
A careless term that disregards pathophysiology 
SG Frangos. Pharmacotherapy 2004; 24(7): 950-952 
...
Transfusion Trigger : 
A careless term that disregards pathophysiology 
SG Frangos. Pharmacotherapy 2004; 24(7): 950-952 
...
Criteri decisionali per l’emotrasfusione 
IInnttrraaooppeerraattoorriioo 
PPoossttooppeerraattoorriioo 
SSeeddee ddii iinn...
Practice Guidelines for Perioperative Blood 
Transfusion and Adjuvant Therapies. 
An Updated report by the American Societ...
L’analisi dei sistemi dedicati e la loro 
discussione dimostrano l’interesse e 
la maggiore sensibilizzazione verso 
la ri...
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2009 siot milano - pavesi - la risorsa sangue in ortopedia valutazione anestesiologiche ed aspetti gestionali

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2009 siot milano pavesi - la risorsa sangue in ortopedia valutazione anestesiologiche ed aspetti gestionali

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  • DOWNLOAD THE BOOK INTO AVAILABLE FORMAT (New Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THE can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THE is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBOOK .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, CookBOOK, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, EBOOK, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THE Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THE the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THE Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
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2009 siot milano - pavesi - la risorsa sangue in ortopedia valutazione anestesiologiche ed aspetti gestionali

  1. 1. 94° Congresso Nazionale SIOT – Milano, 7-11 Novembre 2009 La risorsa sangue in ortopedia : valutazioni anestesiologiche ed aspetti gestionali Dott. Marco Pavesi Serv . Anestesia Polispecialistica IRCCS Policlinico S.Donato
  2. 2. Sostenere una ossigenazione adeguata alle esigenze degli organi vitali
  3. 3. DO2 deve essere sempre adeguato a VO2 EEssiiggeennzzee ffuunnzziioonnaallii Trasporto di O2 DO2 Consumo di O2 VO2 Metabolismo cellulare
  4. 4. Paziente chirurgico rischio di anemizzazione Anemia preoperatoria legata alla patologia propria dell’intervento Prevedibile anemia postoperatoria legata al trauma chirurgico
  5. 5. …….. between 60% and 70% of all red blood cell units are transfused in the surgical setting (Cook 1991; Lenfant 1992; Surgenor 1990; Wallace 1993)
  6. 6. ……… and more recently, that half of all the blood transfused in the United Kingdom is to surgical patients (Regan 2002)
  7. 7. Transfus Med. 2009 Sep 3. The EASTR Study: indications for transfusion and estimates of transfusion recipient numbers in hospitals supplied by the National Blood Service. Wells AW, Llewelyn CA, Casbard A, Johnson AJ, Amin M, Ballard S, Buck J, Malfroy M, Murphy MF, Williamson LM. NHS Blood and Transplant (NHSBT), Newcastle upon Tyne, UK. Recipients grouped into Epidemiology and Survival of Transfusion Recipients (EASTR) Case-mix Groups (E-CMGs) % E-CMGs gastrointestinale 20% vascolare 4% altri 12% nefrologia 5% pediatria 3% ematologia 15% ortopedia 20% ostetricia ginecologia 12% urologica 4% cardiaca 5% 29 representative hospitals over 12 months in 2001-2002
  8. 8. Total hip arthroplasty Dept of Anaesthesia, Cappagh Hospital, Dublin Ann Chir Gynaecol. 1996 Transfusion. 2003 J Bone Joint Surg Am. 1999 444 hip replacement Multicentre Study USA / EU Anesth Analg knee arthroplasty hip arthroplasty 39% 57% 69% 86% 89% 2640 hip and 1305 knee Arthroplasty Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study Orthopaedic Department, Hope Hospital, University of Manchester, Salford, U.K. 330 orthopaedic surgeons in the United States 3920 hip replacement and 5562 total knee replacement Can J Anesth. 1993 97% 20% 2005
  9. 9. SSTTUUDDIIOO SSAANNGGUUIISS revisione della pratica trasfusionale in 43 Ospedali di 10 Paesi UE - Emicolectomia - BPAC - Aneurismectomia AA - TUR/P - Artroprotesi d’anca SI D 0-80% PFC D 0-50% PLT D 0-15% Strategie +/- efficaci Utilizzo inappropriato
  10. 10. LLaa %% ddii ttrraassffuussiioonnii nnoonn ppuuòò eesssseerree ll’’uunniiccoo iinnddiiccaattoorree ddeellllaa ggiiuussttaa aapppplliiccaazziioonnee ddii ssttrraatteeggiiee ddii rriissppaarrmmiioo ssaanngguuee La media di trasfusioni procapite I valori di Ht/Hb basali I volumi di sanguinamento I valori di Ht/Hb alla dimissione I giorni di degenza Le complicanze
  11. 11. Strategie per la riduzione di emotrasfusioni Correzione deficit ddii ccooaagguullaazziioonnee TTeeccnniicchhee cchhiirruurrggiicchhee eedd aanneesstteessiioollooggiicchhee Riduzione dei rischi di sanguinamento EErriittrrooppooiieessii PPrreeddeeppoossiittoo AANNHH Recupero intra/ postoperatorio AAuuttoottrraassffuussiioonnee Limitazione dell’anemizzazione Revisione dei limiti di trasfusione CCrriitteerrii ddii ddeecciissiioonnee ttrraassffuussiioonnaallee
  12. 12. Practice Guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology 1996; 84: 732-747. “……red blood cell transfusions should not be dictated by a single hemoglobin transfusion trigger, but instead should be based on the patient’s risk of developing complications of inadequate oxygenation“ Hb < 6 g/dl , frequently justify RBC transfusion Hb >10 g/dl , RBC transfusions are hardly ever indicated
  13. 13. Transfusion Trigger : A careless term that disregards pathophysiology SG Frangos. Pharmacotherapy 2004; 24(7): 950-952 CCrriitteerriioo Trigger trasfusionale in gruppo eterogeneo iinnddiivviidduuaalliizzzzaattoo Range of Anemia that carries an Increased Risk (RAIR) of morbidity and mortality. Età e sesso patologie presenti (infarto in corso, aritmie attive) anamnesi clinica (infarto recente, patologie polmonari) esame obiettivo (tachicardia, tachipnea) stato funzionale valori di laboratorio esami strumentali di attività cardiorespiratoria ( Ecg, Ecocardiogramma, PFR) .
  14. 14. Transfusion Trigger : A careless term that disregards pathophysiology SG Frangos. Pharmacotherapy 2004; 24(7): 950-952 ssssoooogggglllliiiiaaaa ttttrrrraaaassssffffuuuussssiiiioooonnnnaaaalllleeee rraannggee ddii HHbb rischio calcolato di anemia profilo clinico del paziente Disturbi o alterazioni della fisiologia dei meccanismi di compenso dovrebbero essere criteri di scelta per il trattamento trasfusionale
  15. 15. Criteri decisionali per l’emotrasfusione IInnttrraaooppeerraattoorriioo PPoossttooppeerraattoorriioo SSeeddee ddii iinntteerrvveennttoo MMooddaalliittàà ddii ssaanngguuiinnaammeennttoo MMoobbiilliizzzzaazziioonnee ee FFKKTT MMoonniittoorraaggggiioo Condizioni cliniche MMoonniittoorraaggggiioo PPrreevviissiioonnee ddeell ddeeccoorrssoo Paziente Intervento Vasculopatie polidistrettuali (cardiache e cerebrali) EEttàà PPnneeuummooppaattiiee Ht/Hb
  16. 16. Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies. An Updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies Anesthesiology 2006; 105: 198-208. Raccomandazioni - Monitoraggio delle perdite ematiche -Monitoraggio di una inadeguata perfusione ed ossigenazione degli organi vitali - Monitoraggio delle indicazioni alla trasfusione Hb < 6 g/dl , frequently justify RBC transfusion Hb >10 g/dl , RBC transfusion are hardly ever indicated - Decisione trasfusionale
  17. 17. L’analisi dei sistemi dedicati e la loro discussione dimostrano l’interesse e la maggiore sensibilizzazione verso la riduzione delle richieste di sangue L’applicazione di criteri trasfusionali basati su parametri fisiologici e condizioni cliniche soggettive che vanno oltre il solo riscontro del valore di Ht/Hb rappresentano un tema di studio importante che deve essere affrontato La ricerca con nuovi farmaci e la tecnoclogia con sistemi di monitoraggio sempre più raffinati ci consentiranno di adottare criteri soggettivi di soglia trasfusionale

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