[Blood management in complex reconstructive spine surgery in ASD patients : Do effective measures to reduce bleeding exist?]

BACKGROUND: Blood management in reconstructive spine surgery is a challenge and must be managed interdisciplinarily. An experienced team of anesthesiologists and spine surgeons needs to work closely together.

THERAPY: After optimal preoperative preparation, the patient is given an initial dose of 1000 mg tranexamic acid. The most adequate medium blood pressure is about 80 mm Hg during surgery. The surgeon must watch for subperiosteal preparation and subtle stypsis. A cell saver is used. If the expected blood loss exceeds 1000 ml, additional tranexamic acid of 1000 mg/6 h will be infused. Epidural bleeding as well as bony hemorrhage are challenges for the spine surgeon. Epidural veins should be coagulated under the microscope before they bleed. Bone wax should be used in bony bleeding. If bleeding is uncontrollable, industrially produced hemostyptics can be used.

POST-TREATMENT: Postoperatively the risk of bleeding should be minimized under critical observation of coagulation and blood pressure. Also, a critical assessment of the anticoagulation is to be made. The drainage rate should be well documented. The surgeon must decide whether the drain is to be put on suction or on overflow. He must also decide when to remove the drainage.