Anesthetic Management for Abdominal Aortic Aneurysm Surgey without Homologous Blood Transfusion in Adult Jehovah'sWitness : A case report

Jeong, Ji Yeon; Hur, Won Seok; Lee, Jeong Rim; Jung, Chul Woo; Lee, Kook Hyun

Case Report

General Article

Anesthesia and Pain Medicine 2006;1(1):68-71.
Published online July 30, 2006.

Anesthetic Management for Abdominal Aortic Aneurysm Surgey without Homologous Blood Transfusion in Adult Jehovah'sWitness : A case report

Ji Yeon Jeong, Won Seok Hur, Jeong Rim Lee, Chul Woo Jung, Kook Hyun Lee

Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea. leekh@plaza.snu.ac.kr

Abstract

Jehovah's Witnesses present a challenge for the anesthesia professionals on account of their refusal to accept blood and blood products. Therefore, anesthesiologists must be able to individualize their treatment depending on the patients' condition. We report a case of a stent removal and aorto-biiliac bypass surgery in a Jehovah's Witness. A 69 year-old, hypertensive man presented with claudication of both lower extremities due to the distal migration of an endoaneurysmal stent. According to his previous medical history, he had a lacunar infarction in the right middle cerebral artery territory, ischemic coronary artery disease with a stent in situ, and a stent inserted for an abdominal aortic aneurysm by radiological intervention. Because he strongly refused a transfusion, human recombinant erythropoietin was used before surgery. After the erythropoietin treatment, hemoglobin level increased to 14.8 g/dl (hematocrit 47.6%). During the operation, closed-circuit cell saver was used and transfused autologous blood was saved by acute normovolemic hemodilution. The patient recovered uneventfully from the anesthesia and was transferred to the intensive care unit. He was discharged on the ninth postoperative day without complications with a hematocrit level of 28.9%.

Key Words: acute normovolemic hemodilution, aortic aneurysm, cell saver, erythropoietin, Jehovah's Witness