Acute normovolemic hemodilution is safe in neurological surgery.

Oppiz and Stefani report the use of acute normovolemic hemodilution (ANH) in a prospective study of neurosurgical patients. Patients who received ANH underwent repair of ruptured intracranial aneurysms or resection of intracranial tumors and were compared to a control group who received standard care and underwent craniotomy for aneurysm clipping. ANH patients had hemoglobin levels around 10 g/dL at the end of hemodilution. Results show that ANH did not cause significant changes to laboratory and hemodynamic parameters. There were also no significant differences between groups in terms of intraoperative blood loss, incidence and level of complications, and length of hospital stay. The most interesting finding was an increase in oxygen extraction in ANH patients having a poor preoperative neurological status. Additionally patients in the ANH group with good clinical grade after intracranial aneurysm rupture had a better outcome. This study increases the confidence that in the neurosurgical patient ANH can be a safe alternative to a homologous blood transfusion and its potential complications.

– Amy G. Tsai