ABBREVIATIONSANHacute normovolemic hemodilutionPACUpostanesthesia care unitPerioperative blood management for patients undergoing liver resection has changed a great deal over the past several decades. Advances in surgical and anesthetic techniques and alterations in the definitions of resectability have changed how patients are managed before, after, and during surgery. Currently, manipulation of the central venous pressure, vascular clamping techniques, dissection devices, topical hemostatic agents, and pharmacologic agents such as antifibrinolytics are used to reduce blood loss in liver surgery. The introduction of these techniques, in addition to changes in transfusion thresholds over time, appears to have decreased transfusion rates overall, with a large, single‐center study demonstrating a decrease in transfusion prevalence from 83% in the late 1980s to 43% in the late 1990s. Current evidence suggests that approximately 22% of liver resection patients in North America receive a perioperative transfusion. There is limited high‐quality evidence on the impact of blood loss and blood transfusions in liver resection, although some retrospective data suggest that transfusions may lead to increased complications and cancer recurrence, independent of known confounders. Evidence from other areas of surgery and medicine suggest that a more restrictive use of red blood cell (RBC) transfusions is at least equivalent, or possibly
Transfusion – Wiley
Published: Jan 1, 2018
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