Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review
Safety and efficacy of o-raffinose cross-linked human hemoglobin (Hemolink) in cardiac surgery.
There are currently two major classes of oxygen therapeutics: hemoglobin based oxygen carriers (HBOCs) and synthetic perfluorocarbons (PFCs). This review focuses on the use of o-raffinose cross-linked human hemoglobin (Hb raffimer) in cardiac surgery. ⋯ The converging evidence from clinical studies with HBOCs has demonstrated that these products have the potential to provide hemoglobin and oxygen carrying capacity to tissues in times of acute anemia during surgery. It is anticipated that Hb raffimer will be used to facilitate intraoperative autologous donation and emerge as an important alternative to allogeneic blood transfusion during cardiac surgery.
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Cardiothoracic surgeons and anesthesiologists have had a long-standing interest in the proper use of transfusion therapy for their patients. ⋯ Issues such as the cost of blood, limited availability and the potentially harmful effects of transfusion dictate continued research and the development of methods to appropriately minimize transfusion to patients having cardiac surgery.
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We review the clinically important benefits of the two principal pharmacological strategies, erythropoietin (EPO) and antifibrinolytics (aprotinin and lysine analogues), to decrease transfusion of allogeneic blood products (ABP) during and after cardiac surgery. ⋯ We still need large scale studies to definitely confirm the benefits and exclude the deleterious effects of these drugs on outcomes other than ABP requirements. At present, aprotinin is the only agent that has been shown to reduce the risk of cerebrovascular accident and mortality after cardiac surgery in adults.