Bone marrow procurement

Bone marrow procurement

Anesthesia type	GA vs spinal
Airway	ETT (if GA) vs natural airway (if spinal)
Lines and access	1 PIV
Monitors	Standard ASA monitors
Primary anesthetic considerations
Preoperative
Intraoperative	Very aggressive fluids.
Postoperative	PONV and postop pain are common
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Bone marrow procurement is performed on generally healthy patients who are donating to someone with leukemia. Procurement is typically done on the hip bones (e.g. iliac crest).

Overview

Indications

Bone marrow donation

Surgical procedure

Long ports are inserted into bone marrow and syringes are used to aspirate. Typically done on hip bones in the prone position.

Preoperative management

Patient evaluation

Donors are typically relatively healthy.

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Patient preparation and premedication

Avoid pre-op Tylenol, can give at the end of the case. Everything (Tylenol, steroids) transfers from bone marrow donor to recipient.

Regional and neuraxial techniques

Can be done with spinal, though because of prone positioning, lots of movement, and occasionally lengthy procedure, this is relatively uncomfortable for the patient. Using GA with ETT is generally preferred for this reason.

Intraoperative management

Monitoring and access

PIV x1-2 (at least one good IV for resuscitation)

Induction and airway management

Standard induction as patients are generally healthy.

Positioning

Prone. Arms Superman/above head and accessible.

Maintenance and surgical considerations

• Generally no antibiotics needed
• Avoid nitrous oxide (myelosuppression)
• Avoid steroids (immunosuppression)
• Aggressive fluid repletion, generally ~3:1 repletion with crystalloid. Albumin is often used as well.
  • Can do the case with 1 20G PIV, but easier to keep up with fluid repletion if it is 18G or greater or if have a second IV
• Procedure can be quite painful, consider Dilaudid for postop
• Alternatively consider methadone 0.15 mg/kg (Ideal Body Weight) on induction
• Pretty emetogenic, consider TIVA, scopolamine patch, etc

• Usually harvest 850cc to 1.5L (depends on cell count)

Postoperative management

Disposition

PACU

Pain management

Long acting opioids as above.

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications