[Treatment of acute loss of blood in major elective orthopedic surgery procedures].

Hypovolemia develops when volume of circulating fluid in the body during the surgical procedure and perioperative time is so depleted that effective tissue perfusion can not be maintained and generalized impairment of cellular function is possible. The study was designed to analyze, first, the perioperative acute blood loss in the course of implantation of hip endoprosthesis, and second, the prevention of hemorrhagic shock with regard to morbidity and mortality. In 35 patients, a total hip endoprosthesis was implanted in spinal anesthesia. Prior to surgery and three days following operation, hemoglobin, hematocrit, thrombocyte and APTV analysis was done. Further evaluation included assessment of blood loss during the operation and within 48 h after the surgical procedure until the drainage was removed. The results showed that during the first day postoperatively, the average hemoglobin level was -18 g/L and that of hematocrit -8 vol/% (20%) with fluid substitution by means of blood transfusion and plasma volume expanders (Soludex 1 and 70) maintaining normovolemia. 73% of the patients were given 1270 ml of red blood cells on the first day after the operation, and, on the third day postoperatively, blood transfusion of about 450 ml was administered to 36% of the patients. No functional organ failure was observed. We conclude that the most effective way of treating hypovolemic shock is by the rapid infusion of volume-expanding fluids. There is no optimal level of hematocrit in critically ill patients, so transfusion should be given on individual basis combined with adequate monitoring.