Management of Jehovah's Witness patients undergoing major head and neck surgery

Background. Several diverse strategies have been recommended to manage Jeho vah's Witness patients undergoing surgery when significant blood loss is ex pected. However, many of the proposed management strategies cannot be used when the urgent nature of the disease precludes adequate preoperative prepa ration of the patient. We present our experience of the management of two J ehovah's Witnesses with oral carcinoma requiring extensive resection, neck dissection, and reconstruction with free tissue transfer. Methods. Hypervolemic hemodilution, hypotensive anesthesia, meticulous surg ical hemostasis, and antifibrinolytic therapy were used as an alternative t o blood products or transfusion. Results. Radical surgical ablation and state-of-the-art reconstruction were possible, as a single-stage procedure, even though blood transfusion or bl ood product replacement therapy was refused. Conclusion. Radical surgical ablation of oral carcinoma, with free tissue t ransfer reconstruction, is possible in this group of patients without the u se of blood products or transfusion. There would have been no advantage in raising the red cell mass preoperatively, as the packed cell volume was ide al for free tissue transfer. (C) 1999 John Wiley & Sons, Inc.