Blood wastage reduction: a 10-year observational evaluation in a large teaching institution in France.

Context: Blood transfusion has increased significantly during the last decade and blood wastage reduction is a medical and economic challenge in hospital practice and for institutional quality, particularly in the ICU and operating theatre.

Objective: To evaluate the impact of multiple strategies in one hospital to reduce red blood cell wastage.

Design: Multicentre, prospective, comparative, observational study.

[Blood requirements and transfusion practice evolution in surgery].

During the years 1990, the focus was on transfusion hazards and blood savings strategies. This resulted in a decrease in labile blood products consumption. For a few years, there is a reverse tendency, with a reincrease in blood products consumption.

[Validity of pretransfusion bedside agglutination tests for pretransfusional control].

The incidence rate of ABO hazards of transfusion remains high in France. In this country, bedside pretransfusion controls include an agglutination test for red cells only, although its validity has scarcely been assessed in the practice. 847 nurses from 9 public hospitals and private clinics in a French region participated in a study aimed at measuring the sensitivity and specificity of pretransfusion bedside agglutination tests within hospital wards.

[The use of opioids by the regional route in obstetrics].

Epidural and spinal administration of opioids in obstetrics can be used during labour and for cesarean section. Although these routes of administration are of limited use when opiates are employed as sole agents, the association with local anesthetics may improve the characteristics of analgesia. The administration of a local anesthetic-opiate mixture allows a reduction of the total amount of local anesthetics, thus reducing the incidence of maternal hypotension and the percentage of instrumental extraction.

Rapid pre-operative immunotherapy in a patient allergic to muscle relaxants.

Allergic reactions to muscle relaxants are not uncommon. Although, in most instances, divalent quaternary ammonium salts are involved in these reactions, some monovalent quaternary ammonium compounds can trigger IgE-mediated reactions. A woman who suffered from several episodes of anaphylaxis with divalent (suxamethonium) and monovalent quaternary ammonium salts (tiemonium) needed surgery.