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How to approach orthognathic surgery in patients who refuse blood transfusion

Archives of Plastic Surgery 2020년 47권 5호 p.404 ~ 410
이상환, 김동규, 신호성,
소속 상세정보
이상환 ( Lee Sang-Hwan ) - Soonchunhyang University College of Medicine Department of Plastic and Reconstructive Surgery
김동규 ( Kim Dong-Gyu ) - Soonchunhyang University College of Medicine Department of Plastic and Reconstructive Surgery
신호성 ( Shin Ho-Seong ) - Soonchunhyang University College of Medicine Department of Plastic and Reconstructive Surgery

Abstract


Background: Some patients who need surgery refuse a blood transfusion because of their religious beliefs or concerns about blood-borne infections. In recent years, bloodless surgery has been performed successfully in many procedures, and is therefore of increasing interest in orthognathic surgery.

Methods: Ten Jehovah’s Witnesses who visited our bloodless surgery center for orthognathic surgery participated in this study. To maintain hemoglobin (Hb) levels above 10 g/dL before surgery, recombinant erythropoietin (rEPO) was subcutaneously administered and iron supplements were intravenously administered. During surgery, acute normovolemic hemodilution (ANH) and induced hypotensive anesthesia were used. To elevate the Hb levels to >10 g/dL after surgery, a similar method to the preoperative approach was used.

Results: The 10 patients comprised three men and seven women. Their average Hb level at the first visit was 11.1 g/dL. With treatment according to our protocol, the average preoperative Hb level rose to 12.01 g/dL, and the average Hb level on postoperative day 1 was 10.01 g/dL. No patients needed a blood transfusion, and all patients were discharged without any complications.

Conclusions: This study presents a way to manage patients who refuse blood transfusions while undergoing orthognathic surgery. rEPO and iron supplementation were used to maintain Hb levels above 10 g/dL. During surgery, blood loss was minimized by a meticulous procedure and induced hypotensive anesthesia, and intravascular volume was maintained by ANH. Our practical approach to orthognathic surgery for Jehovah’s Witnesses can be applied to the management of all patients who refuse blood transfusions.

키워드

Blood transfusion; Orthognathic surgery; Jehovah’s Witnesses

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