Reduction of blood loss using aprotonin during
spinal surgery in children for non-idiopathic scoliosis.
Paediatric Anaesthesia, Volume 12: Issue 9
V. Colovic, R.W.M. Walker, D.
Patel, S. Rushman
Aprotinin, a serine protease inhibitor,
reduces surgical blood loss by mechanisms including antifibrinolysis and
preservation of platelet function. Its effectiveness has been reported in adult
patients undergoing cardiac, major orthopaedic surgery (1) and liver surgery,
as well as in paediatric cardiac surgery.
Spinal surgery in children with scoliotic
deformities involves major blood loss. This may often be more than one
circulatory blood volume and therefore results in exposure to blood products
and the accompanying risks and problems. Patients with Duchenne
muscular dystrophy or other neuromuscular conditions presenting for correction
of a spinal deformity pose a particular problem because of their propensity to
bleed during surgery.
Aprotinin was introduced into the RMCH for
the purpose of reducing blood loss in this group of patients in 1999.
Administration of aprotinin carries the risk of the formation of aprotinin
specific antibodies and anaphylaxis. Re-exposure carries a greater risk.
The aim of this study was to investigate the
effect of aprotinin on blood loss during corrective spinal surgery in the
neuromuscular patients.
We have performed a retrospective review of
33 ASA III cases operated on in period June 1998–September 2000. All notes were
studied and data recorded on the intraoperative blood loss and the length of
surgical procedure. Aprotinin was used only in children where it was felt that
they would be unlikely to be re-exposed because of their initial presenting
diagnosis. Our regimen for aprotinin administration was: test dose 5 ml (50 000
KIU) over 20 min, loading dose 2 ml·kg-1
(20 000 KIU·kg-1) infused over 30 min, then maintenance at
0.5 ml·kg-1·hr-1 (5 000 KIU·kg-1·h-1).
In the group that had not received aprotinin
were 15 patients aged 7–17 years (mean age 13 ± 2 years), measured blood loss
was 2849 ± 1802 ml, length of surgery 343 ± 78 min. In the aprotinin group we
had 18 patients aged 7–15 years (mean age 12 ± 2 years) with recorded mean
blood loss of 1380 ± 1000 ml and duration of procedure 389 ± 142 min. The blood
loss in the group that had received aprotinin was significantly reduced (P
< 0.01).
Our two groups of patients were similar
regarding the age of patients, pathology and clinical presentation. We believe
that the use of aprotinin resulted in significant reduction of blood loss and
requirements for blood products.