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Biomedical subjects

L C Stehling

Publications and source records attributed to L C Stehling.

At least 19 recordsLinked to original sources
PubMed1993

Efficacy of preoperative donation of blood for autologous use in radical prostatectomy.

To determine the amount of blood lost, the number of transfusions, and the effectiveness of preoperative autologous blood donation in radical prostatectomy, 163 patients' records from 1987 to 1991 were reviewed at four university hospitals and three community hospitals. Calculated red cell volume lost was 1003 +/- 535 mL (mean +/- SD), which corresponds to 44 +/- 18 percent (mean +/- SD) of total red cell volume. Preoperative donation of blood for autologous use reduced the rate of transfusion of allogeneic blood from 66 to 20 percent (p < 0.001). Of the patients who donated 1 to 2 units, 32 percent received allogeneic blood; 14 percent of those who donated 3 units received allogeneic blood. Donation of 4 units reduced the allogeneic transfusion rate to 11 percent. However, as the number of units donated increased (1-3 units), the units not transfused also increased (0-21%). Ninety-one (56%) of 163 patients donated fewer than 3 units. Autologous blood donation is effective in minimizing the transfusion of allogeneic blood to radical prostatectomy patients, but many patients do not donate enough blood (< 3 units). The donation of 3 units of blood for autologous use is recommended for patients who undergo radical prostatectomy.

Aged↗
PubMed1992

Blood loss and replacement in total hip arthroplasty: a multicenter study. The Preoperative Autologous Blood Donation Study Group.

To determine blood loss, the number of transfusions, and the hemoglobin levels achieved in patients via transfusion in the course of total hip arthroplasty, 324 patient records from 1987 through 1989 were reviewed at three university and three community hospitals. Calculated blood loss was 3.2 +/- 1.3 units in primary procedures and 4.0 +/- 2.1 units in revision procedures (mean +/- SD). Of 777 red cell units transfused, 455 (59%) were autologous units. Transfused patients received 2.0 +/- 1.8 units for primary procedures and 2.9 +/- 2.3 units for revision procedures (mean +/- SD). The maximum number of units given to 95 percent of the transfused patients was 4 for primary procedures and 6 for revision procedures. The mean postoperative hemoglobin level after all transfusions was 103 to 110 g per L, regardless of patient age group of physical status, autologous donor status, or hospital. No difference in length of hospital stay was observed for patients less than 65 years old with hemoglobin concentrations of 80 to 139 g per L at discharge.

Aged↗
PubMed1990

Moderate and severe reactions during autologous blood donations are no more frequent than during homologous blood donations.

Because autologous donation is permitted for donors who do not meet homologous blood donation standards, referring physicians and blood center personnel may be concerned about autologous donor reactions. Small studies have determined that mild reactions do not occur more frequently, but the incidence of rarer, more serious, moderate and severe reactions is unknown. We therefore studied the frequency of reactions during 10,200 autologous and 219,307 concurrent homologous donations at four blood centers. No significant difference was seen for severe reactions: autologous 0.039% (4/10,200), homologous 0.037% (82/219,307) (p = 0.79); moderate reactions: autologous 0.19% (19/10,200), homologous 0.22% (473/219,307) (p = 0.60) or mild reactions: autologous 2.26% (231/10,200), homologous 2.26% (4946/219,307) (p = 0.98). We conclude moderate and severe donation reactions do not occur more frequently among autologous donors who are preselected by referring physicians and screened by blood center personnel.

Blood Transfusion↗
PubMed1989

Strategies for the review of transfusion practices.

The intent of this report is to familiarize health care professionals with the concept of effective quality assurance in regard to blood use. Although evaluation of the appropriateness of transfusion therapy is now required by the Joint Commission on Accreditation of Health Organizations, health care facilities have little experience with this aspect of professional quality assurance. To this end, the Committee on Transfusion Practices of the American Association of Blood Banks, in Arlington, Va, in this report has provided examples of indications and audit criteria for individual blood components and products and commented on areas of controversy surrounding their use. Audit criteria from different institutions may vary because of differences in local interpretation of the indication, different patient populations, and, in some instances, the availability of blood and laboratory services. Several approaches to the review of transfusion practices are discussed in relation to clinical settings and pertaining to particular blood components. It is evident from these examples that there will be an increased need for trained personnel to perform the initial review process as well as for physicians trained in transfusion medicine to oversee the transfusions and provide the necessary consultation.

Blood Banks↗
PubMed1987

Predeposited autologous blood for elective surgery. A national multicenter study.

To determine the extent to which autologous blood that has been donated in advance ("predeposited") is used in patients undergoing elective surgery and to assess whether predonation decreases the use of homologous blood and the demand on the blood supply, we studied 4996 patients undergoing elective surgery at 18 tertiary care hospitals. Cross-matched blood was ordered for 1287 patients (26 percent), and of these, 590 (46 percent) were considered eligible for predepositing blood. Only 5 percent (32) of the eligible patients actually predeposited blood, indicating that predonation is not widely used. Of those who predeposited, only 13 percent (4 of 32) subsequently received homologous blood, as compared with 36 percent (199 of 558) of those who did not predeposit (P less than 0.01). Among the 199 patients who did not predeposit but required transfusion, we estimate that predonation could have avoided homologous transfusion in as many as 68 percent. If all eligible patients had predeposited autologous blood, they could have supplied as much as 72 percent of their own transfused red cells. The blood for as much as 10 percent of all red-cell transfusions could have been predonated by and transfused into the patients undergoing elective surgery. Greater use of predonation would not only reduce the demand on the blood supply by decreasing the need for homologous transfusion, but would probably also reduce the risk of hepatitis and other transfusion-associated illnesses.

Blood Banks↗
PubMed1987

A survey of transfusion practices among anesthesiologists.

A survey of transfusion practices was conducted among anesthesiologists practicing in the United States to determine if significant variation exists and to identify those areas toward which research and educational efforts should be directed. Thirty-seven percent (389) of 1,043 active members of the American Society of Anesthesiologists who received the survey responded. The indications for transfusion as well as the types of components administered were found to vary considerably. Among the areas which need to be addressed are arbitrary preoperative hemoglobin requirements, indications for fresh frozen plasma administration, preoperative blood ordering and autologous transfusion.

Anesthesiology↗
PubMed1986

Underutilization of autologous blood donation among eligible elective surgical patients.

In January 1983, blood banks encouraged the use of autologous blood for transfusion in elective surgical patients due to the advent of transfusion-associated AIDS. Since autologous blood does not transmit hepatitis and other viruses and does not cause alloimmunization, it should be utilized whenever possible. To determine whether patients eligible to predeposit autologous blood before elective operation were actually doing so, we studied patients at three hospitals between January 1 and June 30, 1985. Patients considered eligible for autologous predeposit blood donation were adults with preoperative hemoglobin levels of 11 g/dl or more who underwent elective surgical procedures for which blood transfusion was anticipated. Excluded were patients undergoing cardiovascular, intracranial, or renal transplant procedures. Of eligible patients, only 11 percent (32 of 278) predeposited blood; of these, 81 percent (26 of 32) were transfused with only autologous blood. Among eligible patients who did not predeposit blood, all could have benefited from predepositing because transfusion was likely for the procedure. Of those who did not predeposit, 33 percent (83 of 246) received homologous blood and therefore would have benefited from autologous donation. We conclude that autologous donations are underutilized for medically eligible patients undergoing elective operation.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Anesthesiology update #19. Adverse reactions to transfusion.

Adverse reactions to blood transfusion are not often recognized in the operating room. However, immediate reactions are reported to occur in 5% of patients and delayed reactions in a similar number. Many physicians tend to ignore the risks associated with transfusion and administer blood to achieve some magic end point such as a specific hematocrit or platelet count. Blood products are often administered when crystalloid solutions would suffice. Red cells are administered to increase oxygen carrying capacity and platelets and FFP to promote coagulation. Blood products must not be used as volume expanders. A positive aspect of the AIDS epidemic is increased awareness of disease transmission through transfusion. Many patients are requesting that transfusion be withheld or that they receive only autologous blood. A significant percentage of patients scheduled for elective surgery are candidates for predonation and should be encouraged to do so. Particularly suitable are patients scheduled for spine surgery and total hip replacement.

Blood Group Incompatibility↗
PubMed1979

Cardiovascular responses to diazepam and midazolam maleate in the dog.

Previous clinical studies establishing the efficacy of midazolam maleate (RO 21-3981), a new water-soluble benzodiazepine for induction of anesthesia, have not critically evaluated the effects of this agent on the cardiovascular system. The present study compares the cardiovascular effects of midazolam maleate and diazepam in conscious dogs. Systemic arterial, pulmonary arterial and central venous pressures, cardiac output, LVmax dP/dt, heart rate and regional coronary blood flow were measured 3 min following intravenous administration of diazepam (0.5, 1.0, and 2.5 mg/kg) or midazolam maleate (0.25, 1.0, and 10.0 mg/kg). Midazolam maleate increased heart rate 10--20 per cent with all three doses and decreased mean arterial blood pressure approximately 10--20 per cent at 1.0 and 10 mg/kg. Cardiac output was increased 10--12 per cent with all three doses of midazolam maleate, and LVmax dP/dt was decreased 13--16 per cent at the two higher doses. Diazepam at all three doses did not alter heart rate or mean arterial blood pressure. Diazepam, 1.0 and 2.5 mg/kg, produced significant (17 per cent) decreases in LVmax dP/dt, and 2.5 mg/kg produced a significant (10 per cent) increase in cardiac output. Neither drug in any dosage altered regional coronary blood flow, systemic or coronary vascular resistance, stroke volume, or stroke work. Maximum alterations in cardiovascular variables occurred with doses of midazolam maleate that are 10--15 times the recommended clinical induction dosage. It is concluded that in concentrations necessary for induction of anesthesia midazolam maleate has minimal effects on cardiovascular function.

Animals↗