• The replacement of blood lost during thoracic surgery in children must be done with all the precautions that are observed in adults, but in addition it is imperative that the amounts lost and replaced be measured with exactness.
Blood losses can be followed by actual weighing of the sponges used; it is also possible to estimate the amounts taken up by gowns and drapes. Replacement can be followed by using a burette calibrated to 5-cc. or 10-cc. amounts rather than 25 or 50, and by using a 10-cc. syringe with three-way stopcock to pump the replacement fluid when needed. The replacement should be at least 10 to 15% ahead of the measured loss in volume. The anesthetist and/or surgeon is guided not only by the "in and out balance" but also by the blood pressure, color, and other important clinical signs in the patient.
Proper choice of replacement fluid is essential if hemoconcentration, citrate intoxication, hypercalcemia, and similar complications are to be avoided. Quantitative data from a number of thoracic operations in children illustrate the application of these principles.
Smith RM. BLOOD REPLACEMENT IN THORACIC SURGERY FOR CHILDREN. JAMA. 1956;161(12):1124–1128. doi:10.1001/jama.1956.02970120006002
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