Heroes of Medicine: Bloodless Surgery [an error occurred while processing this directive]

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But for surgeons who are queasy about operating without a transfusion backup, the operating field is not black and white. The jury is still out on whether it is safe to withhold blood, and largescale clinical trials have yet to be performed. Last year an nih-funded study tried to get some answers. Dr. Jeffrey Carson, chief of the division of general internal medicine at the Robert Wood Johnson Medical School in New Brunswick, N.J., studied records of 1,950 bloodless-surgery patients in an effort to determine the relationship between patients' hemoglobin levels and the risk of dying or developing complications after surgery. The results were mixed. The mortality rate was an encouragingly low 3.2%, but Carson also discovered that the risk of complications or death was higher in people with heart disease. "In some circumstances," he says, "blood is lifesaving. When people get very low blood levels, their risk of running into trouble is substantial, and if you're old or have cardiovascular disease, that risk may be even greater. So I recommend caution." Shander is not put off by such fears. "Medicine is very conservative," he says, "which can be good, since it protects doctors against going along with every unproved technique that comes along. But it's imperative that we develop a mind-set where we look at refusing blood not as an obstacle but as a challenge." One way of responding to the challenge might well be the development of artificial blood. The quest for a blood substitute reaches back to the 17th century, when scientists tried to transfuse animal blood and other products into humans. Several blood substitutes are undergoing clinical trials in the U.S. and Europe, and one, which seems to carry oxygen like its genuine counterpart, has been tested successfully in heart-surgery patients in Europe. But for Shander, the problem is a more personal one. "When we're challenged, we extend ourselves," he says. "Some of my colleagues have adopted bloodless medicine purely as a technique.

http://www.time.com/time/reports/heroes/bloodless6.html

05/02/2008

Heroes of Medicine: Bloodless Surgery Others have learned that it also has an impact on ethical and humanistic values. I feel that once you become philosophically committed to practicing bloodless surgery, the benefits to patient and physician alike become more and more apparent. Those are my greatest rewards."

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http://www.time.com/time/reports/heroes/bloodless6.html

05/02/2008