Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 43. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Intraoperative Anesthesia Management Chapter 15 403 ing this approach. Blood collected in the drains within the first 2-4 postoperative hours can also be processed and reinfused with the cell saver system. Pharmacological Measures Tranexamic acid or aprotinin 81 used with the induction of anesthesia has been reported both in adults and children to reduce blood losses in spinal procedures. Because of its price 1 g tranexamic acid costs C vs. C 210 per allogenic blood unitvs. C 338 per autologous blood unitvs. C per vial of 500000 U of aprotinin good tolerance and effectiveness we and others 54 65 prefer tranexamic acid in a protocol of 15-50 mg kg in a bolus with the induction of anesthesia plus an infusion of 1 g h or boluses of 10 - 25 mg kg every 3 h intraoperati-vely and then q8 h for the first 24 h postoperatively. An increase in coagulability changes in kaolin Celite times or severe allergic reactions associated with the use of aprotinin have not been reported with tranexamic acid 26 . Recently the use of aprotinin was associated with a doubling of the risk of renal failure a 55 increased risk of myocardial infarction and a 181 increase in the risk of stroke in cardiac surgery when compared to tranexamic acid 45 . Desmopressin has not proven useful in decreasing blood losses 76 in idiopathic scoliosis surgery. We do not use hemodilution since there is no demonstrated advantage of adding it to patients having CHA and antifibrinolytics. More importantly ION seems to be much more likely to occur when combining anemia or hemodilution and low CHA. Anemia hemodilution and low CHA increase the risk of ION Blood Transfusion and Coagulation Factor Substitution The question of when to start transfusing blood products in spine surgery boils down to what are the thresholds for the red cells RBCs platelets plasma and factors. Blood is separated in blood banks into its components to optimize the use of resources by allowing blood subproducts to be transfused in
