Hurtado P, Garcia-Orellana M, Martinez-Simon A, Pujol-Fontrodona G, Méndez E, Doménech-Asensi P, Pajares A, López-Gómez A, Valencia L, Colomina M J, Fernández-Candil J
Departamento de Anestesiología y Reanimación, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Departamento de Anestesiología y Reanimación, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Departamento de Anestesiología y Cuidados Intensivos, Kepler University Hospital and Johannes Kepler University, Linz, Austria.
Rev Esp Anestesiol Reanim (Engl Ed). 2025 Mar;72(3):501661. doi: 10.1016/j.redare.2024.501661. Epub 2024 Dec 19.
To assess the perioperative management of haemostasis and transfusion practices in adult patients undergoing craniotomies.
Online questionnaire addressed to Spanish anaesthesiologists and promoted by the Neurosciences and Haemostasis, Transfusion Medicine and Fluid Therapy Sections of SEDAR. The questionnaire was sent by email and social media, and was active between June and October 2022.
We obtained 155 responses from 67 centres; 59.4% perform >100 craniotomies per year. 61.7% were regularly involved in neuroanaesthesiology. Only 21.9% of respondents had pre-anaesthesia assessment performed by a member of that section, and in most of them (83.0%) the assessment was performed ≤3 weeks in advance. Of the respondents with Patient Blood Management programmes, 58.2% had no specific protocols for craniotomies. 90.3% reported that haemoconcentrates are systematically reserved. A lower platelet limit of 100,000/µL is considered acceptable by 76.8%. 99.4% of respondents discontinued antiplatelet medication based on half-life. Only 23.9% respondents routinely discontinued non-steroidal anti-inflammatory drugs. The transfusion threshold for haemoglobin during surgical bleeding was <10 g/dL in 18.7%, <9 g/dL in 38.1%, <8 g/dL in 38.7% and <7 g/dL in 4.5%.
Preoperative anaemia screening and treatment programmes are not implemented and blood product reserves are systematised in patients scheduled for craniotomy. Anti-aggregation therapy is discontinued according to the half-life of the drug without checking platelet functionality.
评估接受开颅手术的成年患者围手术期止血管理及输血实践情况。
向西班牙麻醉医师发放在线问卷，由西班牙麻醉与复苏学会神经科学、止血、输血医学与液体治疗分会推动开展。问卷通过电子邮件和社交媒体发送，于2022年6月至10月期间开放填写。
我们从67个中心获得了155份回复；59.4%的中心每年进行超过100例开颅手术。61.7%的受访者经常参与神经麻醉工作。只有21.9%的受访者在麻醉前由该分会成员进行评估，其中大多数（83.0%）在术前≤3周进行评估。在有患者血液管理计划的受访者中，58.2%没有针对开颅手术的具体方案。90.3%的受访者报告称系统性储备了血液浓缩剂。76.8%的受访者认为血小板下限为100,000/µL是可接受的。99.4%的受访者根据药物半衰期停用抗血小板药物。只有23.9%的受访者常规停用非甾体类抗炎药。手术出血期间血红蛋白的输血阈值<10 g/dL的占18.7%，<9 g/dL的占38.1%，<8 g/dL的占38.7%以及<7 g/dL的占4.5%。
对于计划接受开颅手术的患者，未实施术前贫血筛查和治疗方案，而是系统性储备血液制品。抗聚集治疗根据药物半衰期停用，未检查血小板功能。
