by Sheila Smith Noonan
The fear of pain keeps some people from scheduling a routine dental appointment.
But for others facing more invasive procedures, such as oral and maxillofacial
surgery, it may be the fear of receiving a blood transfusion that stands
between them and proper treatment.
Granted, the majority of oral and maxillofacial surgeries generate
very little blood loss. But for certain procedures, such as orthognathic
surgery, maxillofacial reconstructive surgery, and those related
to craniofacial trauma or head and neck cancer, there is a greater
possibility of higher blood loss.
Even the remote possibility of transfusion is enough to deter
Jehovah's Witnesses, who refuse to receive whole blood, red or
white cells, platelets, or blood plasma, for religious reasons,
or people who simply fear a blood transfusion. The modern blood
banks at hospitals are monitored closely and have a very low
possibility of transmission of disease or incompatibility. Nevertheless,
some people still feel uneasy about blood transfusion.
For these patients, there are options that don't compromise treatment
and, in fact, are good surgical techniques, according to Dr.
Vincent Ziccardi, director of the OMS residency program at New
Jersey Dental School. "Probably the most common technique
we use is hypotensive anesthesia, which involves a controlled
lowering of the patient's mean arterial pressure during surgery
through various agents," he says. In addition to reducing
blood loss, the technique can also shorten operating time.
There are other strategies that can be used. Iron therapies help
the body more quickly produce red blood cells, and hemodilution
with crystalloid IV solutions increases blood volume. The latter
is a technique where a unit of the patient's blood is removed
in the operating room and replaced with crystalloid. The blood
is returned to the patient at the completion of surgery while
in the OR. The use of lasers for some specific procedures can
also minimize blood loss. Many of these techniques, such as hemodilution,
can be done in combination with other therapies, Dr. Ziccardi
says. And for some patients, autologous donation, where they
would receive their own blood, brings peace of mind.
What many patients who choose bloodless techniques want is not
only adherence to their preference, but respect for it. The University
Center for Bloodless Surgery & Medicine at University Hospital
has earned a reputation for both. From pediatric tubes and microsampling
for pre-op testing to the use of color-coded charts, wristbands,
and bed signage, the Center is at the
vanguard of this relatively new medical specialty. Coronary bypass
and brain surgery, among other highly specialized procedures,
have successfully been performed at University Hospital using
Dr. Ziccardi and two other NJDS faculty membersDr. Kathy Banks, clinical
assistant professor of OMS, and Dr. Stephen Cantrell, assistant professor
of OMSare affiliated with the Center, which is among the few hospital-based
programs in the country that practice this state-of-the-art approach to
medical and surgical care.
Transfusion-free oral and maxillofacial surgery may seem like
the gold standard of treatment to those providing it. But for
those folks on the receiving end, it's answered prayer.
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