for gynac and upper GI laproscopic surgery..........how much Hb is allowable.....????? what is the fluid management stategies....????????
Depends on the nature and extent of surgery which is not specified.
For elective procedures as per ASA guidelines
Hb less than 6 definitely needs transfusion of pRBC
Hb> 10 definitely does not need any
Hb between 6 and 10 decide based on patient condition esp his cardiorespiratory reserve. Best tested by taking history of EFFORT TOLERANCE and checking his ability to do BREATH HOLDING TEST and SHUTTLE WALKING
Fluids are managed as for any other case. Third space losses may exist because dry gas put into the abdominal cavity may enhance evaporation of water from exposed viscera. ALso gas insuffalation can obstruct venous return to right heart and produce hypotension. This may also need titrated boluses of fluids. Extensive surgeries with risk factors may need CVP monitoring. In other cases urine output can be an effective indicator of vital organ perfusion and hence fluid status.
hello sir,
i would like to spacify the situation... lap hysteractomy,in a pt of 40 year old,,having hb of 8.0 ,due to mannoragia,otherwise normal investigation( ECG,) ,,surgen will take 2 hr for the surgery,and blood loss is usaly 50 -80 cc....,,,should we tranfuse and take the pt for surgery or no need to transfuse..????????
ASA 1, 8 gram and LAVH under GA. Your surgeon is good and does a bloodless job. Ideal will be to transfuse and start. Let there be legal safety. You can start and transfuse after parameter come back to normal.
But, I would give a pint of blood on previous day.