TAKAHASHI Shosuke Kyushu University, Graduate School of Medicine, Professor, 大学院医学研究院, 教授 (30038723)
MORITA Kiyoshi Okayama University, Medical School, Professor, 大学院医歯学総合研究科, 教授 (40108171)
TUZAKI Koichi Keio University, School of Medicine, Associate Professor, 医学部, 助教授 (90138107)
SEO Norimasa Jichi Medical School, Professor, 麻酔科学・集中治療医学, 教授 (40093257)
|Budget Amount *help
¥3,400,000 (Direct Cost : ¥3,400,000)
Fiscal Year 2006 : ¥800,000 (Direct Cost : ¥800,000)
Fiscal Year 2005 : ¥900,000 (Direct Cost : ¥900,000)
Fiscal Year 2004 : ¥900,000 (Direct Cost : ¥900,000)
Fiscal Year 2003 : ¥800,000 (Direct Cost : ¥800,000)
The main sources of hemorrhage were as follows : the abdominal aorta, 15.4% ; the thoracic aorta, 14.0% ; the liver, 12.6% ; intracranium, 8.2% ; the pelvic organs, 8.0% ; celiac or mesenteric artery, 7.8% ; the lung, 7.1%. Of the patients who developed life-threatening events due to surgical hemorrhage, 58.0% were predicted preoperatively to develop massive hemorrhage by anesthesiologists, and 66.7% was informed of the risks of massive hemorrhage and associated complications. The main causes of surgical hemorrhage were as follows : adhesion or invasion, 44.7% ; problems in surgical judgments or techniques, 43.7%. Anesthetic management affected the development of life-threatening events in these patients : lack of infusion prior to hemorrhage, shortage of supportive anesthesiologists, delay in ordering additional blood products, delayed judgment to start blood transfusion, shortage of rapid infusion/transfusion apparatus. Delay in hospitals obtaining blood supply from blood banks was reported in 13.0% of cases, and delayed supply from inhospital blood transfusion service to the operating theater in 16.0%. Despite massive hemorrhage, ABO cross-matching was omitted only in 13.4% of patients, and transfusion of ABO-compatible, in stead of ABO-identical red blood cells, was performed only in 1.3%.
To reduce life-threatening hemorrhagic events in the operating theater, re-organization of emergency medical service and blood supply, improvement of surgical techniques, improved triage of patients with hemorrhagic shock, flexible application of compatible blood products in emergency situations, and improvement of the quality and quantity of anesthesiologists should be considered.