Taha Mohamad, Imtiaz Rizq, Awwab Yumna, Mohamed Sharif
Anesthesiology, Texas Agricultural and Mechanical (A&M) University College of Medicine, Bryan, USA.
Biology, University of Houston-Clear Lake, Houston, USA.
Cureus. 2025 Jul 30;17(7):e89088. doi: 10.7759/cureus.89088. eCollection 2025 Jul.
Hypervolemic hemodilution (HVH) is a blood-sparing technique increasingly used in pediatric neuroanesthesiology, particularly during high-risk procedures such as craniosynostosis repair. By expanding intravascular volume with crystalloids or colloids before surgery, HVH dilutes red blood cell concentration, thereby reducing their loss due to bleeding, while maintaining cerebral oxygenation and hemodynamic stability. This approach is especially valuable in pediatric patients, who are more susceptible to transfusion-related complications due to their limited blood volume and immature immune systems. Compared to acute normovolemic hemodilution, HVH is simpler and equally effective when blood loss is anticipated to be moderate. However, its use requires careful monitoring, as HVH may affect intracranial pressure, cerebral autoregulation, and anesthetic pharmacokinetics. This review highlights the clinical applications, physiologic impacts, and safety considerations of HVH in pediatric neurosurgical care, while identifying gaps in current literature, such as the lack of long-term outcome data and high-quality comparative trials in pediatric patients.
高容量血液稀释（HVH）是一种在小儿神经麻醉学中越来越常用的血液保护技术，特别是在诸如颅缝早闭修复等高风险手术中。通过在手术前用晶体液或胶体液扩充血管内容量，HVH可稀释红细胞浓度，从而减少因出血导致的红细胞丢失，同时维持脑氧合和血流动力学稳定。这种方法在儿科患者中尤其有价值，因为他们由于血容量有限和免疫系统不成熟，更容易出现与输血相关的并发症。与急性等容血液稀释相比，当预计失血量为中等时，HVH更简单且同样有效。然而，其使用需要仔细监测，因为HVH可能会影响颅内压、脑自动调节和麻醉药的药代动力学。本综述重点介绍了HVH在小儿神经外科护理中的临床应用、生理影响和安全考虑因素，同时指出了当前文献中的空白，如缺乏儿科患者的长期结局数据和高质量的对照试验。
