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Skull base surgery. 1996 April; 6(2): 133–136.
PMCID: PMC1656579

Perioperative Management of a Jehovah's Witness Presenting for Skull Base Surgery


A 22-year-old, otherwise healthy, female Jehovah's Witness underwent resection of a midline skull base chondrosarcoma which had been detected after a work-up for headache and diplopia. After bilateral maxillectomies, ethmoidectomies, and a sphenoidectomy, the patient's chondrosarcoma was resected. Despite proper anesthetic management and meticulous hemostasis, significant intraoperative blood loss occurred. The initial postoperative hemoglobin level was 2.3 gm/dL. The clinical concerns pertaining to the perioperative management of the Jehovah's Witness are discussed along with the patient's course and management.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Rothenberg David M. The approach to the Jehovah's Witness patient. Anesthesiol Clin North America. 1990 Sep;8(3):589–607. [PubMed]
  • Jonsen AR. Blood transfusions and Jehovah's Witnesses. The impact of the patient's unusual beliefs in critical care. Crit Care Clin. 1986 Jan;2(1):91–100. [PubMed]
  • Benson KT. The Jehovah's Witness patient: considerations for the anesthesiologist. Anesth Analg. 1989 Nov;69(5):647–656. [PubMed]
  • Henderson AM, Maryniak JK, Simpson JC. Cardiac surgery in Jehovah's witnesses. A review of 36 cases. Anaesthesia. 1986 Jul;41(7):748–753. [PubMed]
  • Henling CE, Carmichael MJ, Keats AS, Cooley DA. Cardiac operation for congenital heart disease in children of Jehovah's Witnesses. J Thorac Cardiovasc Surg. 1985 Jun;89(6):914–920. [PubMed]
  • Ott DA, Cooley DA. Cardiovascular surgery in Jehovah's Witnesses. Report of 542 operations without blood transfusion. JAMA. 1977 Sep 19;238(12):1256–1258. [PubMed]
  • Corno AF, Laks H, Stevenson LW, Clark S, Drinkwater DC. Heart transplantation in a Jehovah's Witness. J Heart Transplant. 1986 Mar-Apr;5(2):175–177. [PubMed]
  • Bonakdar MI, Eckhous AW, Bacher BJ, Tabbilos RH, Peisner DB. Major gynecologic and obstetric surgery in Jehovah's Witnesses. Obstet Gynecol. 1982 Nov;60(5):587–590. [PubMed]
  • Nelson CL, Bowen WS. Total hip arthroplasty in Jehovah's Witnesses without blood transfusion. J Bone Joint Surg Am. 1986 Mar;68(3):350–353. [PubMed]
  • Gaudiani VA, Mason HD. Preoperative erythropoietin in Jehovah's Witnesses who require cardiac procedures. Ann Thorac Surg. 1991 May;51(5):823–824. [PubMed]
  • Lichtiger B, Dupuis JF, Seski J. Hemotherapy during surgery for Jehovah's witnesses: a new method. Anesth Analg. 1982 Jul;61(7):618–619. [PubMed]
  • Lockwood DN, Bullen C, Machin SJ. A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah's Witness. Anaesthesia. 1988 May;43(5):391–393. [PubMed]
  • Leone BJ, Spahn DR. Anemia, hemodilution, and oxygen delivery. Anesth Analg. 1992 Nov;75(5):651–653. [PubMed]
  • Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983 Mar;58(3):277–280. [PubMed]
  • Bourke DL, Smith TC. Estimating allowable hemodilution. Anesthesiology. 1974 Dec;41(6):609–612. [PubMed]
  • Messmer K. Hemodilution. Surg Clin North Am. 1975 Jun;55(3):659–678. [PubMed]
  • Harp JR, Wollman H. Cerebral metabolic effects of hyperventilation and deliberate hypotension. Br J Anaesth. 1973 Mar;45(3):256–262. [PubMed]
  • Thompson GE, Miller RD, Stevens WC, Murray WR. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology. 1978 Feb;48(2):91–96. [PubMed]
  • Michenfelder JD, Uihlein A, Daw EF, Theye RA. Moderate hypothermia in man: haemodynamic and metabolic effects. Br J Anaesth. 1965 Oct;37(10):738–745. [PubMed]
  • ADOLPH EF, LAWROW JW. Oxygen consumptions of hypothermic rats and acclimatization to cold. Am J Physiol. 1950 Jun 1;161(3):359–373. [PubMed]
  • WYNNE NA, FULLER JA, SZEKELY P. Electrocardiographic changes in hypothermia. Br Heart J. 1960 Nov;22:642–646. [PMC free article] [PubMed]
  • MERRILL EW, GILLILAND ER, COKELET G, SHIN H, BRITTEN A, WELLS RE., Jr Rheology of human blood, near and at zero flow. Effects of temperature and hematocrit level. Biophys J. 1963 May;3:199–213. [PubMed]
  • Rittenhouse EA, Ito CS, Mohri H, Merendino KA. Circulatory dynamics during surface-induced deep hypothermia and after cardiac arrest for one hour. J Thorac Cardiovasc Surg. 1971 Mar;61(3):359–369. [PubMed]
  • Lichtenstein A, Eckhart WF, Swanson KJ, Vacanti CA, Zapol WM. Unplanned intraoperative and postoperative hemodilution: oxygen transport and consumption during severe anemia. Anesthesiology. 1988 Jul;69(1):119–122. [PubMed]
  • Westenskow DR, Jordan WS. Changes in oxygen consumption induced by fentanyl and thiopentone during balanced anaesthesia. Can Anaesth Soc J. 1978 Jan;25(1):18–21. [PubMed]
  • Zwischenberger JB, Kirsh MM, Dechert RE, Arnold DK, Bartlett RH. Suppression of shivering decreases oxygen consumption and improves hemodynamic stability during postoperative rewarming. Ann Thorac Surg. 1987 Apr;43(4):428–431. [PubMed]
  • Stone DJ, DiFazio CA. DDAVP to reduce blood loss in Jehovah's Witnesses. Anesthesiology. 1988 Dec;69(6):1028–1028. [PubMed]
  • Chaney MA, Aasen MK. Severe acute normovolemic hemodilution and survival. Anesth Analg. 1993 Jun;76(6):1371–1372. [PubMed]
  • Nearman HS, Eckhauser ML. Postoperative management of a severely anemic Jehovah's Witness. Crit Care Med. 1983 Feb;11(2):142–143. [PubMed]
  • Dudrick SJ, O'Donnell JJ, Raleigh DP, Matheny RG, Unkel SP. Rapid restoration of red blood cell mass in severely anemic surgical patients who refuse transfusion. Arch Surg. 1985 Jun;120(6):721–727. [PubMed]

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