[Risks and side effects of intraoperative autotransfusion].

At the Institute of Anesthesiology of the University of Würzburg, blood has routinely been replaced by autotransfusion in orthopedic and surgical patients since the mid-seventies. At present the Haemonetics-Cell-Saver 3 is used to prepare autologous erythrocyte concentrates. When using this or similar, older, autotransfusion machines, the most dangerous hazard is venous air embolism during manual use despite blood centrifugation and preparation. To avoid this danger, the connecting tube to the patient must be clamped during filling of the autotransfusion bag. During autotransfusion the connecting tube between blood centrifuge and retransfusion bag must be clamped. The time loss due to this management has to be accepted. Regarding coagulation disorders, autotransfusion of large amounts of blood resembles massive transfusion with homologous blood. To maintain coagulation, hemostaseological parameters (Quick, thrombin time, ATIII) should be analyzed at the latest after replacement of half the estimated blood volume. On principle, blood components should be substituted only according to measured values. The substitution of ATIII is most frequently necessary to decrease the hazard of vein thrombosis and pulmonary embolism in these patients. The hazard of blood contamination by suctioning of operating room air should be considered. The number of operating room personnel should be as low as possible. Additionally, the suction device could be constructed to function only when necessary and not continuously. When these safety measures are followed, risks of this effective blood-saving procedure are minimized.