Surgery for Surgeons

Acute anemia is a common reason for transfusion of blood products. The hemoglobin (Hb) threshold for correcting anemia has been a hot topic of discussions for a long time. Here I would like to share my experience and thoughts about this very surgical issue.

About 15 years ago I listened to a talk that was given by a German gastroenterologist who worked at that time in Malawi, a small country in the southern part of Africa. Among other interesting stories, he said that they did not even think about blood transfusion unless there is the number 4 (four!) before the comma in the Hb g/dl level. This was due to a relative lack of blood products but he said also that they never had any problems related to uncorrected acute anemia.
We should assume though, that most of the patients there are generally in a better health that the average patient in the Western world, mostly because of the short life expectancy and very low rate of chronic diseases like Diabetes or Hypertension. Also, as one of my current mentors noted, the rate of patients with sickle cell anemia might be significantly higher there. These patients tend to tolerate much lower Hb levels. Continue Reading »

This is the third part of the posting series “The process of organ procurement”. Please start with the first and second part if you have not done so.

The cold dissection is the part with the most surgical variants and I want to stress again the fact that the described way is the one that I use, well knowing that this is only one of many possible ways to perform an organ procurement in general and a cold dissection in particular.

This is the second part of the posting series “The process of organ procurement”. Please start with the first part if you have not done so.

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The preparation in the OR includes placing of two electrosurgery (”Bovie”) pads and two suction lines.

I usually fixate both arms next to the body unless the anesthesia colleagues have a good reason for extending one or both of them. Shaving and decontamination of the skin I perform only in a line about 5-10 cm on both sides of the midline as I never make lateral incisions.

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There are many ways performing most of the surgical procedures. Everyone of the surgeons has established a way to go for a particular surgery that s/he is most familiar with and trusts the most. In this series of postings (”The process of organ procurement”) I will describe the way I perform the liver and kidney procurements in a Standard Criteria Donation (SCD) situation.
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