Word: patients
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Dates: during 1990-1999
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When Jackson was wheeled into the institute, Dr. Aryeh Shander, chief of anesthesiology and critical-care medicine, and his team moved swiftly. First, they essentially paralyzed the patient with drugs to reduce the demand for oxygen by his muscles, brain, lungs and other organs. Next, they gave him high-potency formulations of iron supplements and vitamins, plus "industrial doses" of a blood-building drug, synthetic erythropoietin, that stimulates the bone marrow to produce red blood cells. Finally, intravenous fluids were administered to goad what little circulation he had left...
...call. It has come up with a panoply of methods and machinery, some of them known for decades but refined and repackaged to fit today's needs and concerns. While bloodless techniques vary from hospital to hospital, they invariably begin with medicinal and nutritional approaches to increase a patient's blood count before surgery. Efforts are made to guard against unnecessary blood loss from tests, and standard blood drawings are either reduced or eliminated altogether. And since an intensive-care patient during an average stay must part with close to a liter of blood for testing--much of it unused...
Still, except for such techniques as radiosurgery, virtually no surgery is completely bloodless. The blood that is shed during operations at places like Englewood may be suctioned out by cell-saving machinery, cleaned and then returned to the patient's body. Red blood cells can also be saved through hemodilution. In this procedure, hemoglobin-rich blood is pumped unit by unit from a vein and replaced by an equal number of units of a nonblood fluid to expand the volume to normal; the patient's own drawn blood is held for use after surgery. In another technique, doctors...
Other factors make bloodless surgery increasingly attractive. Transfusions can suppress the immune system, for example, leaving a patient open to infection, slower healing and a longer recovery time. "Also, banked blood, after it's cooled and stored, doesn't have the capability of fresh blood to transport oxygen," says Shander. "We're just beginning to understand what it is we do when we give a transfusion." Finally, there is the cost: at around $500 for each transfusion, plus administrative add-ons, the total bill comes to between $1 billion and $2 billion annually, more than enough incentive to consider alternatives...
...challenged, we extend ourselves," he says. "Some of my colleagues have adopted bloodless medicine purely as a technique. Others have learned that it also has an impact on ethical and humanistic values. I feel that once you become philosophically committed to practicing bloodless surgery, the benefits to patient and physician alike become more and more apparent. Those are my greatest rewards...