Global blood management in orthopaedic surgery

Blood loss tends to be significant in many orthopaedic procedures because o f the nature of the tissues and the inability to cauterize or coagulate ble eding bony surfaces. Regional hypotensive anesthesia has been useful in red ucing blood loss particularly for joint replacement. A spectrum of measures is available to retrieve autologous blood and reinfuse it. The loop consis ts of predeposit autologous blood, preoperative hemodilution, intraoperativ e and postoperative red cell retrieval, and reinfusion. The safety of autol ogous blood has been accepted universally, but the measures to preserve it must be used judiciously to avoid excessive cost and, most importantly, ens ure patient safety.