Amount Of Perioperative Bleeding Research Articles

A retrospective investigation of the effect of tranexamic acid application and tourniquet duration on postoperative bleeding amount in patients undergoing total knee arthroplasty

Objectives: It is aimed to investigate the effect of tourniquet and tranexamic acid (TXA) on the amount of perioperative bleeding in patients undergoing total knee arthroplasty. Methods: One hundred and ninety-three patients included in the study. The patients included in the study were divided into 4 groups. Group 1 (n = 78) was determined as the patient group with long-term tourniquet application, but without additional application and was accepted as the control group. Group 2 (n = 40) was the long-term tourniquet and intravenous (IV) TXA applied group, Group 3 (n = 40) was the long-term tourniquet and intra-articular TXA applied group, and Group 4 (n = 35) was the short-term tourniquet (only in the cementing phase) and IV TXA applied group. The difference between groups according to use of a tourniquet during the operation, the method and dose of TXA, the amount of postoperative blood transfusion, the amount of drained blood, the length of hospital stay, and complications were investigated. Results: The largest Hemoglobin (Hb) and Hematocrit (Hct) decreases were found in Group 1 (3.39 ± 0.92 g/dl and 10.8%, respectively). Also the highest drainage (median 350 ml), transfusion (16.7%), length of hospital stay (mean 4.51 ± 1.07 days) and estimated blood loss (median 1559.8 ml) were in Group 1 (p < 0.05). The lowest Hb decrease (mean 2.95 ± 0.68 g/dl) and lowest drainage (median 150 ml) was seen in group 3 and the lowest length of hospital stay (mean 3.89 ± 0.8 days) in group 4 (p < 0.05). Conclusions: The use of TXA was shown to lead to a reduction in Hb and Hct, the amount of blood drained after surgery, and the length of hospital stay. The use of TXA may be a good option for bleeding control in patients undergoing total knee arthroplasty.

Impact of anesthetic agents on the amount of bleeding during dilatation and evacuation: A systematic review and meta-analysis.

PurposePatients undergo dilatation and evacuation for abortion or miscarriage. However, bleeding is sometimes problematic. Despite reports on the association between volatile anesthetics and increased bleeding during the procedure, firm evidence is lacking. Therefore, we conducted a systematic review and meta-analysis to compare the effects of volatile anesthetics and propofol on the amount of bleeding in patients undergoing dilatation and evacuation.MethodsWe conducted a systematic search of four databases, namely PubMed, Embase, Cochrane Central Register of Controlled Trials databases, and Web of Science (Clarivate Analytics), from their respective inception to April 2021. Moreover, we searched two trial registration sites. The inclusion criterion was randomized controlled trials of patients who underwent dilatation and evacuation under general anesthesia using volatile anesthetics or propofol. The primary outcome was the amount of perioperative bleeding. The mean difference of the bleeding was combined using a random-effects model. The I2 statistic was used to assess heterogeneity. We assessed risk of bias with Cochrane domains. We controlled type I and II errors due to sparse data and repetitive testing with Trial Sequential Analysis. We assessed the quality of evidence with GRADE.ResultsFive studies were included in the systematic review. The amount of bleeding was compared in four studies and was higher in the volatile anesthetic group, with a mean difference of 164.7 ml (95% confidence interval, 43.6 to 285.7; p = 0.04). Heterogeneity was considerable, with an I2 value of 97%. Two studies evaluated the incidence of significant bleeding, which was significantly higher in the volatile anesthetic group (RR, 2.42; 95% confidence interval, 1.04–5.63; p = 0.04).ConclusionChoosing propofol over volatile anesthetics during dilatation and evacuation might reduce bleeding and the incidence of excessive bleeding. However, the quality of the evidence was very low. This necessitates further trials with a low risk of bias.Trial registrationPROSPERO (CRD42019120873).

Efficacy of Tranexamic Acid on Blood Loss in Thoracolumbar Spinal Fusion Surgery.

To investigate the effectiveness of topical tranexamic acid (TXA) use on bleeding and drain withdrawal time in adult patients undergoing thoracolumbar fusion surgery. Cross-sectional comparative study. Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey, from January 2019 to August 2020. The data of patients, who received thoracic and/or lumbar fusion surgery, were evaluated. The patients were divided into two groups as Group A (30 patients) in which 1 g topical TXA was applied to the surgical site at the end of the surgery; and Group B (30 patients) who did not receive this medication. The body mass index (BMI) and the patients' demographic factors were similar in both the groups. There were no statistically significant differences between the two groups in terms of the surgical time and level, perioperative ES and FFP transfusion rates (p >0.05). While the amount of perioperative bleeding was almost the same (650 mL, p = 0.778), the amount of postoperative bleeding was lower in Group A (138.1 ± 55.6 mL) in comparison to Group B (230.3 ± 65.4 mL). Postoperative ES transfusion was performed on two patients in Group A (6.7%) and six patients in Group B (30%) (p = 0.02). Accordingly, the mean drain withdrawal time in Group A was 3 (2.8-3.0); days, and in Group B, this time was 6 (5.0-6.0) days (p <0.001). Systemic side effects, especially thromboembolism, were not observed in any of the patients. The topical use of TXA in spinal fusion surgery reduced perioperative blood loss. Key Words: Blood loss, Thoracolumbar spinal surgery, Tranexamic acid.

Surgical Invasiveness of Single-Segment Posterior Lumbar Interbody Fusion: Comparing Perioperative Blood Loss in Posterior Lumbar Interbody Fusion with Traditional Pedicle Screws, Cortical Bone Trajectory Screws, and Percutaneous Pedicle Screws.

Study DesignSingle-center retrospective study.PurposeThis study aims to evaluate the surgical invasiveness of single-segment posterior lumbar interbody fusion (PLIF) by comparing perioperative blood loss in PLIF with traditional pedicle screws (PS), cortical bone trajectory screws (CBT), and percutaneous pedicle screws (PPS).Overview of LiteratureIntraoperative blood loss has often been used to evaluate surgical invasiveness. However, in patients undergoing spinal surgery, more blood loss is observed postoperatively than intraoperatively. Therefore, evaluating surgical invasiveness using only the intraoperative bleeding volume may result in considerable underestimation of the actual surgical invasiveness.MethodsThis study included patients who underwent single-segment PLIF between January 2012 and December 2017. In total, seven patients underwent PLIF with PS (PS-PLIF), nine underwent PLIF with CBT (CBT-PLIF), and 15 underwent PLIF with PPS (PPS-PLIF).ResultsNo significant differences were noted in terms of operation time or intraoperative bleeding between the PS-PLIF, CBT-PLIF, and PPS-PLIF groups. However, the postoperative drainage volume in the PPS-PLIF group (210.1 mL; range, 50–367 mL) was determined to be significantly lower than that in the PS-PLIF (416.7 mL; range, 260–760 mL; p=0.002) and CBT-PLIF (421.1 mL; range, 180–890 mL; p=0.006) groups. In addition, the total amount of intraoperative bleeding and postoperative drainage was found to be significantly lower in the PPS-PLIF group (362.8 mL; range, 145–637 mL) than in the PS-PLIF (639.6 mL; range, 285–1,000 mL; p=0.01) and CBT-PLIF (606.7 mL; range, 270–950 mL; p=0.005) groups.ConclusionsBased on our findings, evaluating surgical invasiveness using only intraoperative bleeding can result in the underestimation of actual surgical invasiveness. Even with single-segment PLIF, the amount of perioperative bleeding can vary depending on the way the posterior instrument is installed.

Is the Lateral Decubitus Position Safe and Easy for Laparoscopic Distal Pancreatectomy?

Aims: In this study, we compared the results of laparoscopic distal pancreatic surgery performed in the classical supine position and lateral decubitus position.&#x0D; Study Design: Retrospective cohort study.&#x0D; Place and Duration of Study: The files of 12 patients who underwent laparoscopic distal pancreatectomy in the General Surgery Clinic of our hospital between January 2017 and June 2020 were found by scanning the electronic file system of the hospital.&#x0D; Methodology: Patients who underwent open surgery and whose data were not available, who had distant metastases, had a history of surgery due to other malignancies and those younger than 18 years were excluded from the study. All data were collected by the data collection assistant who was a general surgery and surgical oncology specialist. Clinicopathological records, inpatient treatment epicrisis, radiological examination reports, pathology reports and demographic information of the patients were reviewed.&#x0D; Results: LDP was applied to 9 (75%) patients and LDP + splenectomy procedure was applied to 3 (25%) patients. Postoperative complications were seen in 2 (12.6%) patients. The average operation time was 199.58 minutes. The amount of perioperative bleeding was 111.25 ml. The average length of stay in the hospital is 5.83 ± 0.6 days. All of the patients are alive and the mean survival time is 16.91 ± 2.38 months, with no recurrence.&#x0D; Conclusion: We think that LP provides a significant advantage to the surgeon, since it provides a better viewing angle and facilitates colon mobilization and stomach retraction. This argument can be supported by more patient numbers and studies.

Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

ObjectivesHypothermic circulatory arrest (HCA) has been considered to cause coagulopathy during cardiac surgery. However, coagulopathy associated with HCA has not been understood clearly in details. The objective of this study is to analyze the details of coagulopathy related to HCA in cardiac surgery by using rotational thromboelastometry (ROTEM).MethodsWe retrospectively analyzed 38 patients who underwent elective cardiac surgery (HCA group = 12, non-HCA group = 26) in our hospital. Blood samples were collected before and after cardiopulmonary bypass (CPB). Standard laboratory tests (SLTs) and ROTEM were performed. We performed four ROTEM assays (EXTEM, INTEM, HEPTEM and FIBTEM) and analyzed the following ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF) and maximum clot elasticity (MCE). The amount of perioperative bleeding, intraoperative transfusion and perioperative data were compared between the HCA and non-HCA group.ResultsOperation time and hemostatic time were significantly longer in the HCA group, whereas CPB time had no difference between the groups. The amount of perioperative bleeding and intraoperative transfusion were much higher in the HCA group. SLTs showed no difference between the groups both after anesthesia induction and after protamine reversal. In ROTEM analysis, MCE contributed by platelet was reduced in the HCA group, whereas MCE contributed by fibrinogen had no difference.ConclusionOur study confirmed that the amount of perioperative bleeding and intraoperative transfusion were significantly higher in the HCA group. ROTEM analysis would indicate that clot firmness contributed by platelet component is reduced by HCA in cardiac surgery.

Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre

ObjectiveTo determine whether not waiting for the elimination of direct oral anticoagulants (DOACs) has an effect on the amount of perioperative bleeding in patients who undergo operative treatment of a...

Rigid choledochoscopy via biliary fistula tracts to remove bile duct stones

Objective To study the indications, feasibility and efficacy of rigid choledochoscopy via biliary fistula tracts to remove bile duct stones. Methods A retrospective analysis was performed on the clinical data of 86 patients with bile duct stones treated with rigid choledochoscopy via biliary fistula tracts at our hospital between November 2011 and July 2016. Patients with bile duct stones were divided into the percutaneous transhepatic cholangio drainage (PTCD) group and the T tube tract group. There were 40 patients who underwent lithotomy using rigid choledochoscopy via the PTCD tract and 46 patients who underwent choledocholithotomy using rigid choledochoscopy via the T-tube tract. A comparison was conducted to compare the duration of the procedures, the amount of perioperative bleeding, the postoperative complication rates and residual stone rates between the two groups. Results In the PTCD group, the average operation time was (77.0±36.5) min, the amount of perioperative bleeding was (26.5±54.1) ml, and the postoperative complication rate was 37.5% (15/40). Complete lithotomy in one-stage was successful in 33 patients, and in two-stages in 1 patient. The residual stone rate was 15.0% (6/40). In the T tube tract group, the average operation time was (82.5±44.1) min, the amount of perioperative bleeding was (14.8±21.0) ml, and the postoperative complication rate was 32.6% (15/46). Complete lithotomy in one-stage was successful in 34 patients, and two-stages in 2 patients. The residual stone rate was 21.7% (10/46). There were no significant differences in the residual stone rates, complication rates and operation time between the two groups (P>0.05). The amount of operative bleeding was significantly better in the T tube tract group than the PTCD group, (P<0.05). Conclusions There was no significant differences in the clinical efficacy in the treatment of bile duct stones using choledochoscopy either via the PTCD tract or the T tube tract group. Both approaches can be used for bile duct stones. Key words: Rigid choledochoscopy; Percutaneous transhepatic cholangio drainage (PTCD); Bile duct stones; Cholelithiasis; T-tube; Fistula

Comparative study between sevoflurane and isoflurane on the perioperative and postoperative bleeding of adenotonsillectomy patients

Objective The aim of this study was to compare the effects of volatile anesthetics isoflurane and sevoflurane on intraoperative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy. Patients and methods A total of 64 children classified as American Society of Anesthesiologists class I or II, aged between 2 and 16 years, who were scheduled for tonsillectomy and adenoidectomy were included in this prospective randomized double-blind study. The patients were randomized into two groups, isoflurane group and sevoflurane group, with each including 32 patients. They received balanced general anesthesia with isoflurane concentration 1.2% or sevoflurane concentration 2%. In all patients, the amount of intraoperative blood loss in milliliters was measured by the suction bottle, as well as by weighing the used sponges for each patient. The duration of operation and recovery time were recorded. Results Isoflurane caused significantly lower amount of perioperative bleeding compared with sevoflurane (P=0.03). No significant difference was observed between the two groups in terms of age, BMI, and operation duration, Conclusion Anesthesia with isoflurane can lead to a lower amount of intraoperative bleeding compared with sevoflurane. Therefore, isoflurane may be preferred as an inhalational agent for maintenance of general anesthesia during tonsillectomy and adenoidectomy operations.

Quantifying the Amount of Bleeding and Associated Changes in Intra-Abdominal Pressure and Mean Airway Pressure in Patients Undergoing Lumbar Fixation Surgeries: A Comparison of Three Positioning Systems.

Study DesignProspective, randomised controlled, single centre study of 45 patients posted for two level lumbar fixation surgery in the prone position.PurposeTo compare intra-abdominal pressure (IAP), mean airway pressure mean airway pressure and blood loss during the spine surgery in prone position using three different positioning systems.Overview of LiteratureStudies have correlated IAP with the amount of perioperative bleeding. However, IAP and airway pressures while assessing the bleeding comparing two or more prone positioning systems are unclear.MethodsThis prospective study was conducted on a cohort of 45 patients scheduled for two-level lumbar fixation. Patients were randomly allocated to a spine table, Wilson's frame, and thermomodulated pads. Bladder pressure as an indicator of IAP, mean and peak airway pressures, and blood loss were monitored.ResultsIAP increased whenever patient position was changed to prone .The increase in pressure was more in the Wilson's frame group but was statistically significant only on prolonged positioning. Adopting the prone position always increased the mean airway pressure, but the increased was significant only in the Wilson's frame group. Mean airway pressure decreased in the spine table group and was statistically significant. The blood loss in the spine table group was significantly less as compared to the other groups.ConclusionsPositioning on a spine table results in less blood loss and low mean airway pressure. The Wilson's frame results in high IAP, increased mean airway pressure, and more blood loss. The thermomodulated frame increases mean airway pressure and produces a moderate increase in IAP and airway pressure.

The Effects of Sevoflurane and Isoflurane in Nasal Septal Surgery

The objective of this study was to evaluate the effect of sevoflurane and isoflurane in nasal septal surgery in terms of intraoperative blood loss, operation time, recovery time, and especially postoperative pain. A total of 90 elective nasal septal surgery patients between the ages of 19 and 58 years (mean age, 32.95 years) who were classified as American Society of Anesthesiologists physical status I and II between January 2011 and June 2012 were included the study. Patients were assigned by randomization to receive 1 of 2 anesthetic agents (n = 45 patients each group): balanced general anesthesia with sevoflurane or isoflurane group. In all patients, the amount of intraoperative blood loss, the duration of operation, recovery time, and postoperative pain scores were recorded. The amount of perioperative bleeding in sevoflurane cases was less than that in the isoflurane group, and the difference was statistically significant (P < 0.05). Similarly, mean operative time was shorter in the sevoflurane group, and again the difference between 2 groups was statistically significant (P < 0.05). No statistically significant differences were observed between the 2 groups with respect to the anesthesia duration, extubation time, recovery time, and postoperative pain scores (P > 0.05). Sevoflurane, which is one of the volatile anesthetics, leads to a lower amount of intraoperative bleeding, postoperative pain, and operation time than isoflurane during nasal septal surgery.

Preoperative Embolization of Castleman's Disease Using Microspheres

Castleman's disease is a rare form of lymph node hyperplasia most commonly presenting as a solitary hypervascular mediastinal mass. Surgical resection is the treatment of choice, but this can be associated with significant blood loss due to its hypervascularity. We report two cases with a preoperative diagnosis of mediastinal Castleman's disease in whom preoperative embolization with Trisacryl gelatin microspheres (Biosphere Medical, Rockland, MA) was performed. Compared with the literature, a decrease in the amount of perioperative bleeding was noted in both cases.

Advances in management of paranasal sinus aspergillosis

Surgery remains the treatment of choice for mycetoma of the paranasal sinuses. Itraconazole has a useful role in reducing both the amount of surgery required and the amount of peri-operative bleeding in allergic aspergillosis, and continuing its use post-operatively for six weeks appears to reduce the recurrence rate (although a case-control study is required to validate this observation). In chronic invasive aspergillosis, itraconazole alone appears to be curative, although liver function tests should be monitored and other interactions considered. Imaging is required to monitor resolution; remineralisation occurs after approximately six months. In fulminant aspergillosis, radical surgery and amphotericin B continue to be the treatments of choice. This review discusses the management of aspergillosis of the paranasal sinuses, and in particular the role of itraconazole antifungal therapy.

The effect of training and duration of surgery on adhesion formation in the rabbit model.

In order to evaluate the effect of training upon postoperative adhesions, standard bipolar and mechanical, nonopposing injuries were performed in the uterine horns and side walls of 52 mature female rabbits using a conventional three-puncture laparoscopy, by an endoscopic surgeon with limited experience. An additional injury, either bipolar or mechanical or both, was performed in the retro-uterine space. With experience, the duration of surgery decreased progressively from 12 +/- 2 to 8 +/- 1 min in the first and last 10 animals respectively. The amount of perioperative bleeding was not affected by experience. With experience the postoperative adhesions decreased in extent (P = 0.0001), tenacity (P = 0.004), type (P = 0.002) and inflammation (P = 0.003) and for total score (P = 0.0002). These changes were correlated with the briefer duration of surgery but not with the amount of perioperative bleeding. The strong correlations of adhesion scores in the pouch of Douglas, and around both uterine horns confirmed the importance of the inter-animal variability in making adhesions. By logistic regression, the adhesions in the pouch of Douglas were explained simultaneously by the adhesions on the uterine horns (P = 0.0004, thus correcting for inter-animal variability) by the amount of bleeding (P = 0.01) and the duration of surgery (P = 0.05). No major differences were found in adhesions following a mechanical or a bipolar injury or following such a lesion in the pouch of Douglas or at the uterine horns. In conclusion, experience, expressed by the duration of surgery and to a lesser extent perioperative bleeding, is a major co-factor in postoperative adhesions, suggesting that duration of surgery should be strictly standardized in endoscopic adhesion studies. The important inter-animal variability can be circumvented by using a standard control lesion, making each animal its own control.