Intra-operative
A number of intra-operative management techniques were noted previously
in this paper in Section 5: Alternatives to Blood Transfusion. The
predominant technique evident within the literature is intraoperative
cell salvage due to its general acceptability with Witness
patients11,12,51,56. This is in addition to the use of
intraoperative normovolaemic haemodilution, which was utilised in 37 of
the 45 Witness patients undergoing cardiac surgery in a study by
McCartney et al. 3.
The utilisation of antifibrinolytics, heparinisation and carefully
considered surgical techniques are also discussed within the clinical
literature3,11,57. An example of this is the use of
sternum bone wax as standard for Witness patients in a study by Emmertet al. 58. Other operative aspects such as CPB
and cross clamp times were not significantly different between Witness
and non-Witness groups in various comparative studies (Table 2).
Another point noted from the literature is the importance of
distinctions between adult and paediatric patients. This is highlighted
within case reports and series, such as that by Boettcher et al .,
who reported on three Jehovah’s Witness infants undergoing cardiac
surgery59. In this report, these patients were managed
using a miniaturised extracorporeal circuit and increased crystalloid
cardioplegia59.