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Current Concepts Review   |    
Reducing Perioperative Blood Loss and Allogeneic Blood Transfusion in Patients Undergoing Major Spine Surgery
Eva Y.W. Tse, MBChB1; Wai Y. Cheung, MBBS, FRCS, FHKOS, FHKAM(Ortho Surg)2; Kwok F.J. Ng, MBChB, MD, FANZCA, FHKCA, FHKAM(Anaes), MBA3; Keith D.K. Luk, MBBS, MCh(Ortho), FRACS, FRCSEd, FRCS(Glas), FHKOS, FHKAM(Ortho Surg)2
1 Department of Anesthesiology, F2, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
2 Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Hong Kong SAR, China
3 Department of Anaesthesiology, The University of Hong Kong, Room 424, Block K, Queen Mary Hospital, Hong Kong SAR, China. E-mail address: jkfng@hku.hk
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by the authors of this work are available with the online version of this article at jbjs.org.

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Investigation performed at the Department of Anaesthesiology and the Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jul 06;93(13):1268-1277. doi: 10.2106/JBJS.J.01293
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Abstract

At present, individual techniques, including intraoperative acute normovolemic hemodilution, use of tranexamic acid, use of intrathecal morphine, proper positioning, and modification of operative techniques, seem most promising for reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery.

Other techniques including preoperative autologous predonation; mandatory discontinuation of use of antiplatelet agents; intraoperative and postoperative red-blood-cell salvage; use of aprotinin, epsilon-aminocaproic acid, recombinant factor VIIa, or desmopressin; induced hypotension; avoidance of hypothermia; and minimally invasive operative techniques require additional studies to either establish their effectiveness or address safety considerations.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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