Paracetamol is a weak analgesic with the potential to severely damage the liver, and potential side effects are under debate. As in the adult patient the effect is monitored and where necessary antagonized. The dosage of non-depolarising neuromuscular blocking agents is similar in all age groups, but rocuronium is a long-acting drug in neonates and young infants. In neonates and young infants all opioids, with the exception of remifentanil, are associated with reduced clearance. The dosage of intravenous hypnotics is heavily dependent on the speed of distribution into the periphery, and thus on the cardiac output. The clinically required concentration decreases with increasing age of the infant.
In the case of inhalational agents the alveolar concentration can be measured and the pharmacokinetics thus observed in the individual patient. In neonates and infants in particular off-label use is the rule, not the exception. Unfortunately we have no reliable general rules on how the different drugs behave detailed information from clinical studies is indispensable. Bloodless approaches in selected patients could reduce risks, improve outcomes, and decrease costs for all patients.Īs the child develops, major changes in pharmacokinetics are to be seen, while pharmacodynamic changes are only modest. Given the emerging evidence that patients who avoid ABTs do as well if not better than patients who accept ABTs, further efforts are needed to determine whether all patients could benefit from bloodless strategies. Autologous blood salvage is used for childbirth and surgical patients who have the potential for substantial bleeding.Īlthough there have been few retrospective studies and no prospective studies to guide management, prior studies suggest that outcomes for surgical patients managed without ABTs are comparable to those of historic controls. Low-volume phlebotomy tubes are used for laboratory testing. Anemia is treated with erythropoiesis-stimulating agents as well as iron, folate, and B12 when indicated. We advocate three basic principles: 1) diagnosing and aggressively treating anemia, 2) minimizing blood loss from laboratory testing and invasive procedures, and 3) identifying and managing bleeding diatheses.
Here, we review prior studies and summarize current strategies for bloodless care used at our institution. Advances in our understanding of the risks associated with allogeneic blood transfusions (ABTs) and the growing number of patients who wish to avoid ABTs have led to the emergence of new treatment paradigms for "bloodless" medicine and surgery.
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