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Although most children have short operation time and small amount of blood loss, traumatic heart, chest and abdomen operations are a big test for intraoperative fluid management in children.
The seemingly "small amount" of blood loss during the operation may cause serious anemia.
For the evaluation of blood loss and blood transfusion, a simple method has been introduced before (see How to quickly calculate the blood transfusion), but it is mainly suitable for adults.
It may be wrong to apply directly to pediatric patients.
The formula introduced below is different from that of adults.
Not big, I try to help you understand the meaning of the formula.
Pediatric total blood volume (EBV) assessment of blood transfusion indications "Clinical Anesthesiology" In the case of normal circulatory and respiratory systems, children can tolerate a hematocrit of 25% to 30%, but for infants less than 3 months old, Its hematocrit should be kept above 35%.
"Miller's Anesthesiology" Except for premature babies, full-term newborns, children with cyanotic congenital heart disease or respiratory failure who need to improve oxygen carrying capacity, most children can generally tolerate about 20% of low-level blood cells.
specific volume.
Because neonates with hematocrit less than 30% and premature infants are more likely to have apnea, surgeons and pediatricians need to carefully discuss the minimum target hematocrit for such patients.
Therefore, it is recommended to set Hct of 25% as the lowest limit for normal infants and young children to start blood transfusion, and infants within three months of age should keep Hct above 30-35%.
Evaluating the maximum allowable blood loss is a very important idea.
You should calculate the MABL before the operation starts.
You can know when the operation may require blood gas or directly start blood transfusion.
The calculation formula is estimated to be familiar to many people: MABL= EBV×(Initial Hct-Target Hct)/Initial Hct (Target Hct=25%) This formula assumes that the blood volume remains relatively unchanged during the operation.
The molecule represents the total amount of hemoglobin that can be lost to the greatest extent, and MABL represents these hemoglobins The volume lost in the preoperative state; in fact, since the blood will be slowly diluted during the operation, and also reach Hct=25%, the actual blood loss will be slightly larger than MABL.
It needs to be emphasized that MABL is only an estimate of allowable blood loss.
When the actual bleeding is close to MABL, blood gas verification should be reviewed in time, and blood transfusion should be determined according to the surgical situation.
Calculating the estimated blood transfusion volume When you decide to transfusion, the question becomes how much red blood cells should be transfused.
At this time, the transfusion volume should not be calculated in units (U), but in milliliters.
Estimated blood transfusion volume (ml) = EBV×(expected Hct-measured Hct)/packed volume of concentrated red blood cells (approximately 60%).
This formula assumes that the blood volume during transfusion remains relatively constant, and the molecule represents the expected increase in hemoglobin The total amount of these hemoglobin using concentrated red blood cells is the estimated blood transfusion volume.
We know that 1U concentrated red blood cells is less than 200ml, and the volume of red blood cell suspension or leukocyte suspension prepared from 200ml whole blood of different people is not equal.
Sometimes the actual volume may be marked on the blood bag or checklist.
Generally speaking, 1U red blood cells are mostly 120-160ml, and the blood volume should be applied based on the calculated volume.
For example: a child, 1 year old, 12 kg, with a preoperative Hct of 42%, intends to undergo laparotomy.
MABL=12×70×(42-25)/42=340ml; if the blood loss is less than 340ml, it should be supplemented with 1:3 sodium lactate solution.
If the actual Hct measured in the middle of the operation is 27%, the concentration of red blood cells to be transfused will increase to 35%.
Therefore, the estimated blood transfusion volume=12×70×(35-27)/60=112ml, the actual 1u concentrated red blood cell is about 120-160ml, so 1u red blood cell transfusion is sufficient.
Finally, to summarize: Generally speaking, when the blood transfusion indication is not reached, the intraoperative blood loss is supplemented by 1:3 sodium lactate Ringer; when the blood loss is close to the maximum allowable bleeding (MABL), and postoperative blood loss is not easy to occur At this time, red blood cell transfusion is still not necessary; but if postoperative bleeding has occurred or may occur, you should discuss with the surgeon to actively start blood transfusion.
There are very few studies on the use of colloidal fluid in children, and it is not recommended, unless it is a large amount of blood loss but cannot be transfused in time, albumin or hydroxyethyl starch and the amount of bleeding should be supplemented 1:1.
Hope to give you a harvest! Recommendation: Three words to understand blood pressure deeply
The seemingly "small amount" of blood loss during the operation may cause serious anemia.
For the evaluation of blood loss and blood transfusion, a simple method has been introduced before (see How to quickly calculate the blood transfusion), but it is mainly suitable for adults.
It may be wrong to apply directly to pediatric patients.
The formula introduced below is different from that of adults.
Not big, I try to help you understand the meaning of the formula.
Pediatric total blood volume (EBV) assessment of blood transfusion indications "Clinical Anesthesiology" In the case of normal circulatory and respiratory systems, children can tolerate a hematocrit of 25% to 30%, but for infants less than 3 months old, Its hematocrit should be kept above 35%.
"Miller's Anesthesiology" Except for premature babies, full-term newborns, children with cyanotic congenital heart disease or respiratory failure who need to improve oxygen carrying capacity, most children can generally tolerate about 20% of low-level blood cells.
specific volume.
Because neonates with hematocrit less than 30% and premature infants are more likely to have apnea, surgeons and pediatricians need to carefully discuss the minimum target hematocrit for such patients.
Therefore, it is recommended to set Hct of 25% as the lowest limit for normal infants and young children to start blood transfusion, and infants within three months of age should keep Hct above 30-35%.
Evaluating the maximum allowable blood loss is a very important idea.
You should calculate the MABL before the operation starts.
You can know when the operation may require blood gas or directly start blood transfusion.
The calculation formula is estimated to be familiar to many people: MABL= EBV×(Initial Hct-Target Hct)/Initial Hct (Target Hct=25%) This formula assumes that the blood volume remains relatively unchanged during the operation.
The molecule represents the total amount of hemoglobin that can be lost to the greatest extent, and MABL represents these hemoglobins The volume lost in the preoperative state; in fact, since the blood will be slowly diluted during the operation, and also reach Hct=25%, the actual blood loss will be slightly larger than MABL.
It needs to be emphasized that MABL is only an estimate of allowable blood loss.
When the actual bleeding is close to MABL, blood gas verification should be reviewed in time, and blood transfusion should be determined according to the surgical situation.
Calculating the estimated blood transfusion volume When you decide to transfusion, the question becomes how much red blood cells should be transfused.
At this time, the transfusion volume should not be calculated in units (U), but in milliliters.
Estimated blood transfusion volume (ml) = EBV×(expected Hct-measured Hct)/packed volume of concentrated red blood cells (approximately 60%).
This formula assumes that the blood volume during transfusion remains relatively constant, and the molecule represents the expected increase in hemoglobin The total amount of these hemoglobin using concentrated red blood cells is the estimated blood transfusion volume.
We know that 1U concentrated red blood cells is less than 200ml, and the volume of red blood cell suspension or leukocyte suspension prepared from 200ml whole blood of different people is not equal.
Sometimes the actual volume may be marked on the blood bag or checklist.
Generally speaking, 1U red blood cells are mostly 120-160ml, and the blood volume should be applied based on the calculated volume.
For example: a child, 1 year old, 12 kg, with a preoperative Hct of 42%, intends to undergo laparotomy.
MABL=12×70×(42-25)/42=340ml; if the blood loss is less than 340ml, it should be supplemented with 1:3 sodium lactate solution.
If the actual Hct measured in the middle of the operation is 27%, the concentration of red blood cells to be transfused will increase to 35%.
Therefore, the estimated blood transfusion volume=12×70×(35-27)/60=112ml, the actual 1u concentrated red blood cell is about 120-160ml, so 1u red blood cell transfusion is sufficient.
Finally, to summarize: Generally speaking, when the blood transfusion indication is not reached, the intraoperative blood loss is supplemented by 1:3 sodium lactate Ringer; when the blood loss is close to the maximum allowable bleeding (MABL), and postoperative blood loss is not easy to occur At this time, red blood cell transfusion is still not necessary; but if postoperative bleeding has occurred or may occur, you should discuss with the surgeon to actively start blood transfusion.
There are very few studies on the use of colloidal fluid in children, and it is not recommended, unless it is a large amount of blood loss but cannot be transfused in time, albumin or hydroxyethyl starch and the amount of bleeding should be supplemented 1:1.
Hope to give you a harvest! Recommendation: Three words to understand blood pressure deeply
