Thorne A C, Stewart M, Gulati S C
Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
J Clin Oncol. 1993 Feb;11(2):320-3. doi: 10.1200/JCO.1993.11.2.320.
To evaluate the results of outpatient bone marrow harvest (BMH).
Seventy-two adult patients with various malignancies had 79 BMH procedures performed for future autologous bone marrow transplantation (BMT) in our institution's outpatient surgical facility. All patients were evaluated and educated before the procedure. Newer anesthetic agents specifically developed to have shorter half-lives, more rapid recovery from general anesthesia, and fewer unpleasant side effects were chosen. Propofol was used for induction of anesthesia in 76 patients, the other three were induced with sodium pentothal. The blood volume removed was replaced by colloid (6% hydroxyethyl starch). Also, a new parenteral nonnarcotic pain medication, ketoroloc, was used during the last part of general anesthesia to help with expected postoperative pain in 76 patients.
BMH took 111 +/- 24 minutes and patients were in postanesthesia care unit (PACU) for 220 +/- 72 minutes before being sent home with a companion and Tylenol with codeine (acetaminophen with codeine; McNeil Pharmaceutical, Spring House, PA). PACU complications were minor and included transient mild dizziness (7.6%), vomiting (3.8%), and fever (2.6%). No life-threatening complication was observed. Only one patient was hospitalized for observation (fever) and then sent home. Seventy-five patients (94.9%) were contacted at home by the hospital nursing staff the day following the procedure. Five (6.7%) complained of nausea or vomiting, and four (5.3%) developed fever at home (temperature, 37.2 to 38.3 degrees C). Only 36% of patients actually took oral narcotic pain medication at home.
Autologous BMH (AuBMH) is a safe outpatient procedure with minimal side effects when newer anesthetic agents are used.
评估门诊骨髓采集（BMH）的结果。
72例患有各种恶性肿瘤的成年患者在本机构的门诊手术设施中接受了79次BMH操作，用于未来的自体骨髓移植（BMT）。所有患者在操作前均接受了评估和教育。选用了专门开发的半衰期更短、从全身麻醉中恢复更快且不良反应更少的新型麻醉剂。76例患者使用丙泊酚诱导麻醉，另外3例使用硫喷妥钠诱导麻醉。采集的血容量用胶体（6%羟乙基淀粉）替代。此外，在全身麻醉的最后阶段，76例患者使用了一种新型非肠道非麻醉性止痛药物酮咯酸，以缓解预期的术后疼痛。
BMH耗时111±24分钟，患者在麻醉后护理单元（PACU）停留220±72分钟，之后由同伴陪同并服用含可待因的泰诺（对乙酰氨基酚含可待因；麦克尼尔制药公司，宾夕法尼亚州斯普林霍斯）回家。PACU的并发症较轻微，包括短暂的轻度头晕（7.6%）、呕吐（3.8%）和发热（2.6%）。未观察到危及生命的并发症。仅1例患者因发热住院观察，之后回家。术后第1天，医院护理人员对75例（94.9%）患者进行了家访。5例（6.7%）患者抱怨恶心或呕吐，4例（5.3%）患者在家中出现发热（体温37.2至38.3摄氏度）。只有36%的患者在家中实际服用了口服麻醉性止痛药物。
当使用新型麻醉剂时，自体BMH（AuBMH）是一种安全的门诊操作，副作用最小。
