Key messages

• The increasing number of transfusion recipients and the shortfall of blood donors calls for the development of artificial oxygen carriers as part of perioperative transfusion-sparing strategies.

• Hemoglobin-based oxygen carriers are suitable for 1:1 replacement of lost blood, but have shortcomings due to pharmacokinetic (short half-life) and pharmacodynamic (vasoactivity) properties as well as logistical (hemoglobin supply) problems.

• Perfluorocarbon emulsions transport oxygen in physically dissolved form. They have to be administered in low doses (risk of reticuloendothelial system overload), and intubation and hyperoxic ventilation of the recipient is required; therefore they are suitable mainly for elective surgical procedures allowing for preoperative acute normovolemic hemodilution.

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