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2013 anemo nurse - albano - gestione del recupero perioperatorio
1. 28 giugno 2013
San Donato Milanese
AANNEEMMOO NNUURRSSEE
GGEESSTTIIOONNEE DDEELL RREECCUUPPEERROO PPEERRIIOOPPEERRAATTOORRIIOO
A cura di
Giovanni Albano
Responsabile U.O. Anestesia e Rianimazione
3. RECUPERO POST OOPPEERRAATTOORRIIOO …… PPEERRCCHHEE’’ …… ??????
The Demographic Problem from Aging Baby-Boomers
(Σ people aged 0-14) + (Σ people aged ≥65)
(Σ people aged 15-65)
x 100
Life expectancy with sustained quality of life
Fertility rate down
Dependency ratio =
4. RECUPERO POST OOPPEERRAATTOORRIIOO …… PPEERRCCHHEE’’ …… ??????
Impact of the Ageing Population on Blood Demand
the 70- to 80-year-olds have an eightfold higher RBC
consumption than 20- to 40-year-olds
7. RREECCUUPPEERROO PPOOSSTT OOPPEERRAATTOORRIIOO …… PPEERRCCHHEE’’ …… ??????
CCHHIIRRUURRGGIIAA OONNCCOOLLOOGGIICCAA
The Immunomodulation Effect of allogenic blood trasfusion in
colorectal cancer
“ … ricorrenza significativa tra ripetizione locale di neoplasia e trasfusioni
(P< 0,001) …. “
Coll Antropol 2006 Dec - Sebalic S. et coll.
8. RREECCUUPPEERROO PPOOSSTT OOPPEERRAATTOORRIIOO …… PPEERRCCHHEE’’ …… ??????
Effect of substituting allogenic blood transfusion with
autologous blood transfusion on outcomes after radical
esophagectomy for cancer
“ … aumento cellule T killer naturali circolanti nel gruppo non trasfuso …. “
Takemura M., Osuzi H. – Ann.Surg.Thorac.Cardiovasc. Ott 2005
11(5:293-300)
CCHHIIRRUURRGGIIAA OONNCCOOLLOOGGIICCAA
9. RECUPERO POST OOPPEERRAATTOORRIIOO …… PPEERRCCHHEE’’ …… ??????
MAX AUTOLOGOUS BLOOD*
to reinfuse with closed system
autotransfusion drainage systems
MAN WOMAN
50-60 kg 650 ml 550 ml
60-70 kg 750 ml 650 ml
70-80 kg 850 ml 750 ml
80-90 kg 950 ml 850 ml
90-100 kg 1000 ml 950 ml
>100 kg 1000 ml 1000 ml
Patient's
weight
* Based on Eurosets’ clinical experience
10. RECUPERO POST OOPPEERRAATTOORRIIOO …… PPEERRCCHHEE’’ …… ??????
Recupero Perioperatorio delle Perdite Ematiche
….. it has been previously reported that for a total unwashed
salvaged blood volume of 1000–1500 mL there is enough circulating
haptoglobin to bind the reinfused plasma free Hb, avoiding possible
renal damage …..
Muñoz M, García-Vallejo JJ, Ruiz MD, et al. Transfusion of postoperative shed
blood: laboratory characteristics and clinical utility.
Eur Spine J 2004; 13(Suppl. 1): S107–13
11. RECUPERO POST OOPPEERRAATTOORRIIOO …… PPEERRCCHHEE’’ …… ??????
“Cochrane 2006 meta analisi (studi randomizzati) 1++”
Utilizzo di RPO riduce la % di pazienti trasfusi con sangue allogenico
Efficacia > in chirurgia ortopedica rispetto alla cardiochirurgia
Poca differenza in chirurgia ortopedica tra sangue non lavato e lavato
Non sembrano le complicanze post-operatorie (trombosi,
infezioni,reintervento per sanguinamento, infarto miocardico)
13. RREECCUUPPEERROO PPOOSSTT OOPPEERRAATTOORRIIOO …… PPEERRCCHHEE’’ …… ??????
“… L’EFFICACIA DEL RECUPERO POST OPERATORIO NON E’
INFLUENZATA DALL’UTILIZZO DI SSAANNGGUUEE LLAAVVAATTOO
O NNOONN LLAAVVAATTOO …”
16. RECUPERO POST OOPPEERRAATTOORRIIOO …… CCOOMMEE …… ??????
“ .. Blood quality and side effects should be appreciated
against the background of recent efforts of improvements
Hansen and Pawlik.
Transfusion 2004;44:45s-53s
in transfusion .. “
17. RECUPERO POST OOPPEERRAATTOORRIIOO …… CCOOMMEE …… ??????
“… IL CAMBIAMENTO DI STATO DEL SANGUE NEL MOMENTO DELLA
FUORIUSCITA DALLA SUA SEDE NATURALE
PUO’ ESSERE LIMITATO MA E’ IMPOSSIBILE IMPEDIRLO…..”
Marco Ranucci - San Donato 1991