Blood and Fluid Management During Scoliosis Surgery
Blood and Fluid Management During Scoliosis Surgery
In the present retrospective study, it was hypothesized that application, in scoliosis
 surgery, of a protocol for blood and fluid management, based on goal directed fluid therapy,
 cell salvage and tranexamic acid, could lead to reduced allogeneic red blood cells
 transfusion. The patients will be enrolled in a retrospective observational study and divided
 in two groups. Patients in no protocol Group received a liberal intraoperative fluid therapy
 and patients in protocol Group received fluid therapy managed according to a stroke volume
 variation based protocol. The protocol included fluid therapy according to SVV monitor,
 permissive hypotension, tranexamic acid infusion, restrictive RBC trigger and use of
 perioperative cell savage.
At investigators institution, neither anesthetic approaches to replacement of blood or fluid
 losses were standardized before 2014 for scoliosis surgery. Before 2014, fluid therapy was
 liberal and according to general principles of good clinical practice and ephedrine boluses
 of 5 mg were given when fluid boluses failed to maintain a systolic arterial pressure >90 mm
 Hg. Blood was replaced with crystalloid at a 3:1 ratio and colloid at a 1:1 ratio. Regarding
 blood product transfusion anesthesiologists were generally initiated when hemoglobin levels
 were less than 8 g/dl or less than 10 g/dl in patients with coronary diseases and predonated
 autologous or allogeneic RBCs were administered.

 A protocol of management for scoliosis surgery was implemented in 2014 and included: a) fluid
 therapy according to SVV monitor, b) intraoperative permissive hypotension to reduce active
 bleeding (goal mean arterial pressure 60 mmHg), c) prophylactic tranexamic acid infusion (30
 mg/kg bolus, 1mg/kg/hr during surgery), d) restrictive RBC trigger according to national
 standardized protocols (Hb<7.0 g/dL or <9g/dL in patients with coronary diseases) and e) use
 of perioperative cell savage.

 In patients of Group Pro, basal crystalloid infusion was started at 4 ml/kg/h right after
 general anesthesia induction and intubation. ClearSight System (Edwards Lifesciences Cop,
 Irvine, CA, USA) was used to measure stroke volume variation and cardiac output, continuously
 and noninvasively through finger- cuffed technology. If SVV was >15% rapid crystalloid bolus
 of 10ml/kg or 4ml/kg colloid bolus were administered until it reached a value of ≤15%. After
 two consecutive fluid boluses SVV remained >15%, administration of noradrenaline infusion was
 considered.

 Data will be collected from anesthesia records and included: age, gender, height, weight,
 body mass index and ASA score. Additional variables included infused crystalloid volume,
 infused colloid volume and the number of allogeneic transfused units of RBC. Serum Hb levels
 were measured preoperatively and after the end of surgery. Moreover, diuresis and use of
 vasopressors use were recorded.
Inclusion Criteria:

 1. severe curve (Cobb Angle > 70-degree)

 2. same surgeon in all procedures

 Exclusion Criteria:

 1. Patients with coagulopathy,

 2. morbid obesity

 3. severe cardiopulmonary disease

 4. liver dysfunction

 5. renal disease