Amount Of Postoperative Bleeding Research Articles

The Effect of Thrombin-gelatin Matrix Compared With Absorbable Gelatin Sponge on Intraoperative Hemostasis in Unilateral Open-door Laminoplasty: A Randomized Controlled Trial.

Prospective, randomized, parallel-controlled trial. The primary aim of this study was to determine whether hrombin-gelatin matrix (TGM) combined with an absorbable gelatin sponge (AGS) could more greatly reduce Intraoperative blood loss (IBL) in unilateral open-door laminoplasty than the sole use of an AGS could. The secondary aims were to evaluate the hemostatic efficiency, amount of postoperative bleeding and safety of the application of TGM combined with an AGS. IBL during cervical laminoplasty is substantial and is a proper indication for the application of hemostatic agents. However, we are unaware of any clinical trials on the application of TGM and an AGS in posterior cervical spine surgery. A total of 80 consecutive patients who underwent unilateral open-door laminoplasty, were enrolled from September 2020 to March 2022. Patients were randomized into two groups, the TGM-AGS group and the AGS group, with 40 patients in each group. The primary outcome was IBL. Other outcomes included the duration of operation, duration of hemostasis, duration of drainage, maximum decrease in hemoglobin(Hb), length of hospital stay, volume of drainage, number of drainage days, occurrence of adverse events, coagulation indicators and patient-reported outcome measures (PROMs). The mean IBL for patients in the TGM-AGS group (75.22mL ±21.83mL) was significantly lower than that in the AGS group(252.43mL ±57.39mL)(mean difference=177.21mL, 95% confidence interval [CI], 157.88mL -196.53mL, t=18.25, P<0.001); the duration of hemostasis, volume of drainage, days of drainage in the TGM group and maximum decrease in Hb were also significantly less than those in the AGS group (P<0.01). The hemostatic efficacy of TGM-AGS is better than that of an AGS alone in IBL. TGM-AGS is also superior to an AGS alone in the evaluation of hemostatic efficiency and postoperative bleeding.

Is prophylactic intraoperative transfusion needed in unilateral total knee arthroplasty? Comparison of hematologic data and postoperative transfusion rate between a prophylactic allogenic or autologous transfusion group with a no-transfusion group: A preliminary retrospective cohort study

ObjectivesTo determine whether prophylactic intra-operative allogenic or autologous transfusion could prevent postoperative anemia and additional transfusion comparing to the control group without receiving any prophylactic intervention in unilateral total knee arthroplasty. Materials and methodsThis study included 711 patients who underwent unilateral TKA. They were divided into four groups: allogeneic transfusion group (group AL), autologous transfusion group (group AT), tranexamic acid group (group TA), and control group (group C). The primary outcome was rate of postoperative allogeneic blood transfusions. Secondary outcomes were postoperative hemoglobin and hematocrit levels, postoperative bleeding amount. ResultsGroups AT and AL did not exhibit a significant reduction in postoperative allogenic blood transfusion rate compared to group C (28/108 vs. 20/108, p = 0.21 and 37/159 vs. 34/159, p = 0.78 respectively). However, group TA demonstrated a significantly lower rate of postoperative allogenic blood transfusions than group C (22/125 vs. 3/125, p = 0.0001). Postoperative hemoglobin and hematocrit levels were statistically higher in group TA than in group C. However, those levels in group AT and AL did not differ significantly from those of group C. ConclusionIntra-operative prophylactic transfusions did not decrease postoperative anemia or additional postoperative transfusion compared to the control group in patients undergoing total knee arthroplasty. However, the group receiving tranexamic acid showed lower transfusion rate and higher levels of hemoglobin and hematocrit.

Evaluation of IUD Insertion During CS In 100 Patient. A Prospective Study

Background: The application of an IUD to the female after placenta delivery during a caesarean section had several benefits since the female was under anesthetic, which reduced the need for additional manipulation and pain, and the female at the time of delivery had a strong desire for family planning. IUDs placed postpartum experienced numerous disengagements, including bleeding and displacement. Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section in 100 patients. Patient and methods: A prospective study was conducted at obstetrics and gynecology department of Damanhur Medical National Institute in the period from March 2022 to March 2023. Group I: included 52 women who agreed to insert immediate post placental IUD at the cesarean delivery. Group II: included 48 women as control group. The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: In both groups, the demographic information was comparable. The medical histories of the investigated patients and the control group did not differ significantly according to our research. The study group's caesarean procedure took a little longer to complete. There were no appreciable differences between the two groups in terms of infection, puerperal hemorrhage, or IUD displacement. Both groups' satisfaction levels were displayed as either pain or displacement. In the research and control groups, the expulsion rates were 3.92% and 0.00%, respectively. Conclusion: Based on our research, we draw the conclusion that IUD insertion during CS is safe and effective, avoiding the reasons why it can be challenging to insert an IUD after puerperium and having a low expulsion rate; so, it can be considered a standard procedure.

Low-Dose Heparin Protocol in Type A Aortic Dissection Surgeries.

We aim to compare the heparin dose regimen in terms of bleeding, reoperation rate due to severe bleeding, and the amount of transfusion of the blood products in patients who underwent surgery for type A aortic dissection (TAAD). Between January 2018 and August 2021, 90 adult patients who underwent for TAAD were included. Primary outcome measures were postoperative bleeding amount and blood product transfusion requirements. Two different protocols performed in TAAD surgery in our clinic. In this pre- and postimplementation study, before October 2019, the standard-dose heparin protocol (SH group) was used and after November 2019, the low-dose heparin protocol (LH group) was used and two groups were compared. Mechanical ventilation duration, length of intensive care unit and hospital stay, postoperative drainage volumes, blood product transfusions, reoperations due to bleeding, and in-hospital mortality rates were recorded. The dosages of heparin and activated clotting time values, as well as the additional heparin requirement, were significantly different between the two groups (p < 0.001). Standard-dose heparinization was needed only in 33.3% of patients in the LH group. In the SH group, postoperative total drainage and red blood cell (RBC) transfusion were significantly higher than the LH group (p = 0.036 and p = 0.046, respectively). We found that the low-dose heparin regimen resulted in significantly less postoperative total drainage and RBC transfusion requirement in patients who underwent for TAAD.

Use of Tranexamic Acid in Liposculpture: A Double-Blind, Multicenter, Randomized Clinical Trial.

Intraoperative hemostasis should be performed with great caution because bleeding is a huge enemy of patient safety during surgery. Tranexamic acid is a lysine synthetic derivate that inhibits fibrinolysis and diminishes the bleeding by blocking the five lysine-binding sites for plasminogen. The authors compare the efficacy of tranexamic acid versus placebo as a hemostatic agent in liposculpture procedures. The authors conducted a multicenter, double-blind, randomized, controlled clinical trial in patients who were scheduled for liposculpture in three plastic surgery centers (Colombia and Mexico) between January of 2019 and February of 2020. One hundred forty-one patients were randomly assigned into three groups: intravenous (1 g of tranexamic acid), subcutaneous (1 g of tranexamic acid), and placebo (normal saline). Forty-seven patients were assigned to each group. There were 30 male patients and 111 female patients. The main outcome was to evaluate the amount of postoperative bleeding between groups. The primary outcome was measured by the hemoglobin point loss at day 1 (preoperative hemoglobin minus hemoglobin at day 1 postoperatively) and the hemoglobin (in milligrams per deciliter) point loss at day 5 (preoperative hemoglobin minus hemoglobin at day 5 postoperatively). The authors found the intravenous intervention group to have a greater hemoglobin level than the other two groups on both the first postoperative day ( p = 0.0001) and the fifth postoperative day ( p = 0.001). There were no statistical differences in hemoglobin values between the placebo and the subcutaneous intervention groups. Intravenous tranexamic acid is a good therapeutic choice to implement on liposculpture procedures to decrease postoperative bleeding. The preoperative use of intravenous tranexamic acid not only decreases the bleeding rate after liposuction procedures, but also allows greater lipoaspirate volumes when performing high-definition liposculpture. Further studies are required to support the effectiveness of tranexamic acid within the infiltration solution. Therapeutic, I.

Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass.

Background: In cardiac surgery, supraphysiological oxygen levels are frequently applied perioperatively. In this study, we examined the postoperative effect of perioperative hyperoxemia in cardiac surgery. Methods: All patients who underwent mitral valve replacement via the standard sternotomy method between 2010 and 2021 were analyzed by scanning the hospital data system. The patients were divided into 2 groups: the hyperoxemic group (partial pressure of oxygen/fraction of inspired oxygen [PaO2/FiO2] > 500 mmHg) (Group I) and the normoxemic group (300 mmHg < PaO2/FiO2 < 500 mmHg) (Group II) according to the mean of 3 PaO2/FiO2 values calculated by using 3 PaO2 and 3 FiO2 levels. Postoperative complications, the mechanical ventilation time, the need for noninvasive mechanical ventilator support, the length of intensive care unit (ICU) stay, the hospitalization period, and the mortality rate of the groups were compared. Results: A total of 78 patients were included in the study, and 53 of the patients (67.9%) were female. The mean age of the patients was 58.89±12.60 years. The total mechanical ventilation time was significantly higher in the hyperoxemic group than in Group II (P<0.001) (18.18±12.90 h and 11.45±7.85 h, respectively). The amount of postoperative bleeding was significantly higher in Group I (P=0.003) (539.47±201.74 mL and 417.50±186.93 mL, respectively). The total amount of blood products administered during surgery and ICU stay was higher in Group I (P=0.041) (3.55±1.59 units and 2.87±1.89 units, respectively). Conclusion: We observed that the group with hyperoxemia during cardiopulmonary bypass had a higher amount of postoperative bleeding and the need for transfusion, as well as a longer duration of mechanical ventilation and intensive care.

Application of Nanoparticles in Diagnosis and Treatment of Pancreatic Cancer.

Objective In order to study the application of nanoparticles in the diagnosis and treatment of pancreatic cancer, we retrospectively analyzed pancreatic cancer patients after operation. Method 60 cases of pancreatic cancer and surgical treatment were selected from our hospital. The time ranged from March 2018 to March 2019. The age ranged from 27 to 81 years. There were 36 males and 24 females, with an average age of 46.23 (7.63) years. Among them, the observation group consisted of nanotube artificial tubes, 16 males and 14 females, while the control group adopted nylon tube, male 18 and female 12. The patient was diagnosed by abdominal CT, and the patient's demographic data and basic clinical data were recorded at the same time. Result In this study, 60 patients were divided into groups and compared. The patients underwent surgical resection of pancreaticoduodenum and reconstruction of pancreaticoduodenal papillary duct. Among them, the observation group used nanocomposite artificial tube, while the observation group used nanocomposite artificial tube and placed drainage tube to drain the peritoneal effusion to prevent the effusion from forming in abdominal hypertension and infection. The amount of postoperative bleeding, operation time, and postoperative concomitant symptoms were observed, and the differences between the two materials were analyzed. Conclusion The reconstruction of pancreaticoduodenal papillary duct with nanomaterials has certain advantages for postoperative recovery, reduces postoperative complications, reduces the probability of infection, and improves the therapeutic effect.

Recuperadores de sangre postoperatorios tras la artroplastia de rodilla: ¿siguen siendo útiles? Un estudio de cohortes retrospectivo

Background and Goal of Study: Blood salvage (BS) is important to implement the second pillar of Patient Blood Management to avoid anaemia after total knee arthroplasty (TKA). Our primary outcome was to assess BS usefulness to decrease allogenic blood transfusion (ABT) rate in TKA. Materials and Methods: a retrospective, observational cohort study was conducted on consecutive patients scheduled for TKA with BS or not. Demographic, comorbidity, surgical and anesthetic data, laboratory pre and postoperative results, volume of blood drained, and reinfused from BS and the requirement of ABT were recorded. Parametric and non-parametric tests were employed. p&lt; 0.05 was accepted as significant. Results: 260 patients were included (130 per cohort). The amount of postoperative bleeding was 713.1 +445.4 ml. 26.5% received ABT. BS reduced transfusion in 13,1% (p=0,024) with RR 1,65 (CI 1,085-2,52)]. Risk factors for postoperative bleeding were: male gender, atrial fibrillation, preoperative anti-platelet therapy and cementless primary TKA. Risk factors for ABT: ASA &gt; II, preoperative hemoglobin &lt; 13 g/dl, knee revision, anti-platelet therapy, longer surgery time. Patients transfused had lower hemoglobin values (p&lt;0.001), and longer medium LOS (+2.5 days, p=0.026). Conclusion: The use of BS in TKA showed benefits reducing allogenic blood transfusion and length of hospital stay. BS would remain an effective, safe and cheap alternative to tranexamic acid in patients with high risk of thromboembolism events operated of TKA.

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 &amp;lt; 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 &amp;lt; 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.

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.

Study on the Protective Effect of Platelet Autotransfusion in Cardiopulmonary Bypass

Objective: To study the blood protective effect of platelet autotransfusion in cardiopulmonary bypass. Methods: In this study, 80 patients with cardiopulmonary bypass heart surgery in our hospital from January 2018 to July 2019 were divided into two groups. The control group was not given platelet separation, the study group was given platelet separation after anesthesia induction, platelet rich plasma was extracted before heparinization for cardiopulmonary bypass and heparin was recycled. The blood clotting function, postoperative recovery, blood transfusion volume and postoperative drainage volume were analyzed before operation, 1H, 24h and 48h after operation. Result: Compared with the control group, the volume of blood flow, blood plasma and platelet transfusion in the study group decreased significantly in the first hour after operation, the difference was statistically significant (P &lt; 0.05). The recovery of the study group was slightly better than that of the control group, and the difference was not statistically significant (P &gt; 0.05). Conclusion: Autotransfusion of platelets can alleviate the coagulation function of patients undergoing cardiopulmonary bypass, reduce the amount of postoperative bleeding and allogeneic blood transfusion, and protect the blood.

A comparison of high thoracic epidural anaesthesia versus conventional intravenous opioids in pediatric patients undergoing corrective open heart surgery for ventricular septal defect

Background: We compared high thoracic epidural anaesthesia with a combination of morphine and bupivacaine versus IV fentanyl as an alternative for perioperative pain management.Methods: Group-E: Injection Morphine 75-100 mcg/kg and Injection 0.25 % Bupivacaine 0.5 ml/kg was given via epidural catheter at insertion, Injection 0.25% Bupivacaine 0.5 ml/kg just before skin incision, and continuous infusion of Injection 0.125% Bupivacaine at 0.2 ml/kg/hr intra-operatively. Post-operative 0.1 ml/kg/hr infusion. Group F- intravenous fentanyl 2-3 mcg/Kg IV bolus given just before skin incision, followed by 1-2 mcg/Kg/hr IV fentanyl started after weaning from cardiopulmonary bypass.Results: The mean ScvO2 was comparable between the two groups during induction period but became higher in group E during bypass and post bypass period intraoperatively, and the difference in rise in ScvO2 is statistically significant with a p&lt;0.05. The mean rSo2- C was comparable between the two groups in the first postoperative hour but group F shows higher rSo2-C postoperatively which was statistically significant. The postoperative pain was significantly lower in group E in the postoperative period (except for 4,5,6 and 40 and 48th hour).Conclusions: HTEA to paediatric patients prior to sternotomy for cardiac surgeries resulted in a much better control of haemodynamic parameters. Produces better central venous and regional tissue oxygenation during bypass and post bypass intraoperatively as compared to the patients that received only intravenous fentanyl. There was lower amount of postoperative bleeding in the HTEA group with significant reduction in requirement of post-operative ventilation and time to extubation after surgery, better post-operative pain control and overall outcome.

Evaluation of post-placental IUD insertion during cesarean section at a Tertiary care Hospital in Egypt

objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to December, 31, 2017.Two groups of patients were selected; each group included 60 patients with desire of birth control. The group I was subjected to post-placental intrauterine device (IUD) insertion and group II was subjected to interval IUD insertion (3 months after cesarean delivery). Both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients' satisfaction. Results: The demographic data were comparable in both groups. The duration of cesarean surgery was slightly prolonged in the study group. The infection, puerperal bleeding, and displacement of IUDs were not significantly different in both groups. The discontinuation rate after 6 months was 5.88% in study group compared to 8.33% in the control group. The satisfaction rate in both groups were 90.20%, 91.67% in study and control groups respectively. The expulsion rates were 3.92% and 0.00% in the study and control groups respectively. Pregnancy on top of IUD was 3.92% in study group and 4.17% in control group with p.value =0.949. Conclusion:Post-placental IUD insertion was found to be a sound, safe and effective clinical approach taking advantages of the possible desire of patients for immediate contraception , so achieving the right goal of pregnancy spacing and decreasing unintended pregnancies.

Effect of deep neuromuscular blockade on serum cytokines and postoperative delirium in elderly patients undergoing total hip replacement: A prospective single-blind randomised controlled trial.

Deep neuromuscular blockade (NMB) may reduce muscle injury and related inflammation. The inflammation is one of the pathophysiological processes of peri-operative complications. To compare the degree of inflammation and related postoperative complications including postoperative delirium (POD) and peri-operative bleeding according to the degree of NMB during general anaesthesia for total hip replacement. A prospective, single-blind, randomised controlled trial. Tertiary, university hospital, single centre. Eighty-two patients undergoing total hip replacement surgery were included in the final analysis. Moderate (Mod) and deep (Deep) NMB groups. The changes in inflammatory cytokines were measured. The incidence of POD was evaluated by using confusion assessment method (CAM). The differences of postoperative bleeding and peri-operative oxygenation in both groups were also measured. The NMB reversal duration was significantly longer in the Mod NMB group than in the Deep NMB group. Changes in interleukin-6 were significantly smaller in the Deep NMB group than in the Mod NMB group (P < 0.001). The incidence of POD was not significantly different between groups (34 versus 17% in Mod and Deep NMB groups, respectively; P = 0.129). The amount of postoperative bleeding until postoperative day 2 was significantly greater in the Mod NMB group than in the Deep NMB group (P = 0.027). Our findings suggest that inflammation related to peri-operative complications could be associated with the depth of NMB during total hip replacement. However, the incidence of POD might not be associated to the depth of NMB. National Library of Medicine (NLM) at the National Institutes of Health (NIH) of United States. (Identifier: NCT02507609). Online address: http://clinicaltrials.gov.

Comparison of the hemostatic suture with non-suture cold-knife conization methods for cervical surgery

Objective: The primary purpose of this study is to compare the suture with non-suture cold-knife after conization methods. Method: The study included 172 women who underwent the cold-knife conization.. In the first group, patients underwent cold-knife conization without sutures, and in the second group, patients underwent cold-knife conization with suture. The essential variables of this study include blood loss, duration of operation, number of pregnancies, type of childbirth, and age of the patient. The results are calculated based on t-test, Fisher exact test, chi-square, and nonparametric Mann-Whitney tests. Result: There was no significant difference between the variables studied, including blood loss (p-value = 0.185). The only significant difference was in the duration of operation (P-value = 0.000). Conclusion: Our findings showed that there was no significant difference between the amount of blood loss between the sutured and non-sutured groups. These results also showed that the operation duration was significantly reduced. This result was excepted since there was no need for suturing, and the other stages of the procedure were the same throughout the cold knife canonization in both groups. Due to the shorter operation duration, no difference in the amount of postoperative bleeding, and the specific risks of suture, it is suggested to use a non-suture technique for cold-knife conization.

The Effectiveness of Tranexamic Acid in Patients With Proximal Femoral Tumor Resection Prosthesis.

Aim: The aim of this study is to evaluate the risk of thromboembolic events and amount of postoperative blood loss and transfusion in patients who received preoperative tranexamic acid (TXA) administration in proximal femoral resection and endoprosthesis of proximal femur malignant lesion.Methods: In this study, the data of 46 patients who underwent extensive resection and proximal femoral tumor prosthesis for proximal femoral bone malignancies were retrospectively reviewed. Patients were divided into two groups according to preoperative 15 mg/kg bolus intravenous administration of TXA. These patients were compared in terms of postoperative blood loss, postoperative bleeding, and transfusion requirements.Results: There were 46 patients (18 female, 28 male) with a mean age of 60.7±14.7 (19-89) years. Fifteen patients (32.6%) were treated with iv TXA. In the TXA group (46.7%), there was a statistically significant decrease in the need for transfusion compared to the patient group (93.5%) without TXA (p=0.001). Postoperative 24th hour, 48th hour,and total drainage blood loss values were found to be significantly lower in the TXA group (p=0.047, p=0.015, and p=0.019, respectively). There was no thromboembolic event observed.Conclusion: Because of proximal femoral malignancy, extensive tumor resection and preoperative bolus 15 mg/kg TXA administration in proximal femoral prosthesis surgery significantly decreased the amount of postoperative bleeding and transfusion requirement without increasing the risk of thromboembolic event.Level of Evidence: Level III - retrospective comparative study.

Predictiveness of different preoperative risk assessments for postoperative bleeding after coronary artery bypass grafting surgery.

Postoperative bleeding is a significant cause of morbidity and mortality in patients undergoing cardiac surgery. Studies have been conducted, and guidelines have been published regarding patient blood management and aiming to prevent blood loss in the perioperative period. Various bleeding risk assessments were developed for preoperative period. We aimed to examine the correlations of scoring systems in the literature with the amount of postoperative bleeding in patients undergoing first time coronary artery bypass graft surgery, and to show the most suitable preoperative bleeding risk assessment for coronary artery bypass graft patients. The study included 550 consecutive patients who underwent coronary artery bypass graft operation. The inclusion criteria were considered as patients to be older than 18 years old and to undergo elective or emergent myocardial revascularization using cardiopulmonary bypass. All variables required for scoring systems were recorded. The initial results of the study were determined as the amount of chest tube drainage, the use of blood products, the change in hematocrit level, reoperation due to bleeding, duration of ventilation, duration of intensive care unit stay, and hospital stay. Mortality which occurred during first 30 days after operation was considered as operative mortality. Operative mortality was accepted as the primary endpoint. Secondary endpoints were massive bleeding and high amount of transfusion. Data were obtained from a series of 550 consecutive patients treated with isolated coronary artery bypass graft. It was seen that PAPWORTH and WILL-BLEED risk assessments responded better for E-CABG grade 2 and 3 bleeding compared to other risk assessments. TRACK, TRUST, and ACTA-PORT scales were found to have low ability to distinguish patients with E-CABG bleeding grade 2 and 3. Predicting postoperative bleeding and transfusion rates with preoperative risk scores in patients undergoing coronary artery bypass graft surgery will provide valuable information to physicians for establishing a proper patient blood management protocol and this will decrease excessive transfusions, unnecessary reoperations as well as improve postoperative outcomes.

Evaluation of Post-Placental IUD Insertion during Cesarean Section at a Tertiary Care Hospital in Egypt

Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. Background: IUD could be applied to the female after delivery of placenta during cesarean section, it had many advantages as the female is under anesthesia so no extra manipulation needed, decrease pain, and also the female at the period of delivery had high motive for family planning. Post placental IUD insertion also had many disengages like bleeding and displacement. Material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to May 31 2019. Two groups of patients were selected; each group included 60 patients with desire of birth control. The group I was subjected to post-placental intrauterine device (IUD) insertion during cesarean section and group II was subjected to interval IUD insertion (3 months after cesarean delivery). The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: The demographic data were comparable in both groups. The duration of cesarean surgery was slightly prolonged in the study group. The infection, puerperal bleeding, and displacement of IUDs were not significantly different in both groups. The discontinuation rate after 12 months was 13.72% in study group compared to 16.66% in the control group. The satisfaction rates in both groups were 90.20%, 91.67% in study and control groups respectively. The expulsion rates were 3.92% and 0.00% in the study and control groups respectively. Pregnancy on top of IUD was 1.96% in study group and 4.17% in control group with p value = 0.949. Conclusion: Post-placental IUD insertion is found to be safe, easily applied during cesarean section with slight prolongation of cesarean section duration. Post-placental IUD insertion is also effective, with few complications compared to interval IUD insertion. This modality of insertion was accepted by the great majority of patients being painless and at the same time of surgery with no added cost or maneuver and utilizing the enthusiasm of patients for immediate contraception. The continuation rates are good in the study follow up duration.

Effects of Coronary Artery Bypass Grafting Surgery on Olfactory and Taste Functions.

Olfactory and taste sensations have a high impact on the quality of life. Impaired olfactory and taste functions may have a negative effect on physical and mental well-being, personal hygiene, and nutritional satisfaction, leading to the occurrence of depressive symptoms and impaired quality of life. Therefore, the recovery period of patients with disturbed olfactory and taste functions may be prolonged, and return to active life may be delayed. We designed this study to determine whether on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have any effects on olfactory and taste functions and compare these functions between the surgical groups. A total of 60 patients, who underwent elective isolated first-time CABG, were included in this study. Patients were divided into two groups as Off-Pump and On-Pump CABG groups with 30 patients in each group. In addition to patients' primary clinical and laboratory data, olfactory and taste functions were evaluated pre- and postoperatively in both groups separately, and then these functions were compared between the groups. Olfactory functions were evaluated by the Brief Smell Identification Test, while taste functions by the Burghart Taste test. Olfactory functions significantly were disrupted in the postoperative period in patients undergoing on-pump CABG (P value < .05), while these functions significantly were not affected in patients undergoing off-pump CABG (P value > .05). During the preoperative period, advanced age and smoking were detected to be independent predictors of impaired olfactory function for the study population. During the postoperative period, smoking, amount of postoperative bleeding and serum low-density lipoprotein (LDL) level were found to be independent predictors of impaired olfactory function for just the On-Pump CABG Group. In both groups, no significant deterioration in taste functions occurred during the postoperative period (P value > .05). Our study demonstrated that olfactory function was impaired in patients, who underwent on-pump CABG in the postoperative period, and significant impairment in taste function was present in neither off-pump nor on-pump CABG patients. However, the results of our study should be supported by more comprehensive, prospective, randomized controlled trials with more extensive patient series and by further tests.

Prognostic factors for maxillary sinus mucosal thickening following Le Fort I osteotomy: a retrospective analysis

BackgroundLe Fort I osteotomy is one of the surgical procedures now routinely and safely performed. It is possible to move the maxilla in three dimensions, but it is necessary to separate the bones around the maxillary sinus. Therefore, with surgery, maxillary sinus mucosal thickening occurs. By knowing the changes in the sinus mucosa after surgery and the factors affecting it, it is possible to better predict the outcomes of surgery and contribute to safer surgery. In this study, thickening of maxillary sinus mucosa before and after surgery in Le Fort I osteotomy was evaluated using multidetector-row computed tomography (MDCT) images, and the changes in mucosal thickening and the related factors were examined.MethodsUsing MDCT images, the maxillary sinus mucosa of 125 patients who had undergone Le Fort I osteotomy was retrospectively evaluated before surgery, 1 month after surgery, and 1 year after surgery. On the MDCT images, the maxillary sinus was judged as mucosal thickening and classified into three grades according to the proportion occupying the maxillary sinus. In the evaluation of factors related to mucosal thickening, the following eight factors were examined: sex, age, diagnosis, operating time, amount of postoperative bleeding, with/without bone graft, with/without multisegmental osteotomy, and with/without macrolide therapy after surgery.ResultsThe mean age at the time of surgery was 25.6 ± 8 years. Of all 125 patients, 66 had bilateral thickening, 19 had unilateral thickening, and 40 had no thickening. Factors that were significantly related to mucosal thickening were the operative time for the maxilla, bone grafts, and macrolide therapy after surgery.ConclusionsOperative time for the maxilla, bone grafts, and macrolide therapy after surgery were found to be related to mucosal thickening. In addition, MDCT scanning 1 month after surgery was considered to be appropriate for evaluation of maxillary sinus mucosal thickening.