Blood Loss Drainage Research Articles

Use of Tranexamic Acid at Knee Joint Arthroplasty

Results of comparative study of the efficacy and safety of intraoperative application of tranexam versus autoplasma in patients with planned surgical blood loss and high risk of venous thrombosis development has been presented. One hundred seven patients admitted for total knee replacement were divided into 2 groups. In the main group (55 patients) intraoperative intravenous infusion of 10 mg/kg tranexam were used. In the control group (52 patients) intraoperative hemodilution with autoplasma was performed. Hemostasis indices (APTT, INR, SFMC, D- dimer) and lysis index were studied before surgery and in postoperative period. Ultrasound scanning of lower extremity veins was performed before surgery and in 4—5 days after intervention. The volume of intraoperative blood loss in two groups did not differ. In the postoperative period the drainage blood loss in the main group was more than twice lower as compared to the control group (p=0,037). In postoperative period statistically significant increase in SFMC and D-dimer indices was noted in both groups. However after tranexam application the increase in fibrin lysis products content was reliably less marked than in control group. US investigation of lower extremities showed distal veins thrombosis in 2 patients from control group and no cases of thrombosis in the main group.

Fibrin tissue adhesive reduces postoperative blood loss in total knee arthroplasty

BackgroundBlood transfusion is often required in total knee replacement; various methods of blood preservation have been studied. The best solution is to reduce the loss of blood during and after surgery.Materials and methodsWe designed this study to evaluate the hemostatic efficacy and safety of fibrin tissue adhesive (Quixil) in patients receiving total knee arthroplasty [low contact stress (LCS, DePuy, Warsaw, IN, US) cementless total knee replacement (TKR)] with a prospective, randomized, standard treatment controlled study. Thirty-five patients were randomized to receive treatment with fibrin tissue adhesive (treatment group), and 35 were randomized to be managed with postoperative blood recovery and reinfusion (control group). Blood loss in suction drain, decrease in hemoglobin values, and transfusions were recorded.ResultsA significant reduction in apparent total blood loss was detected in the treatment group compared with the control group. There was also a lower decrease in hemoglobin level, although this difference was not significant. When fibrin tissue adhesive was administered, the need for transfusions was lower. No major adverse events were recorded in our series.ConclusionsFibrin tissue adhesive reduced blood loss in TKR and seemed to significantly reduce the need for blood transfusion. Fibrin tissue adhesive can be an appropriate solution to enhance hemostasis and vessel sealing at the operative site in TKR, in order to reduce blood loss after surgery and the risk of complications.

Evaluation of blood loss and significance of postoperative autotransfusion in knee joint alloplasty

The aim of this paper is to evalute perioperative blood loss associated with total cemented knee joint alloplasty, with special regard to specific factors that may influence this loss. Additionally, the significance of postoperative autotransfusion in these procedures is assessed. The study group consisted of 85 patients (61 females and 24 males); in 32 cases a postoperative autotransfusion system was used (CBCII ConstaVac, Stryker). Factors analysed comprised pre- and postoperative hemoglobin levels, drain blood loss, heterologous blood transfusion volume and reasons for the transfusion, including co-morbidities. Allogeneic blood transfusion was necessary in 54.72% of the patients who did not have autotransfusion and in 34.38% of the patients who received autotransfusion. The mean volume of blood collected in the drains was 882 ml, while the mean volume of reinfused blood amounted to 524.2 ml. Hypertensive patients experienced greater postoperative blood loss. The average drop in hemoglobin levels was 3.6 g/dl and was smaller by 0.6 g/dl in patients who received autotransfusion. The lowest preoperative hemoglobin values occurred in patients who required heterologous blood transfusion despite autotransfusion. Heterologous blood transfusion was performed at a hemoglobin level of 8.4 g/dl; in patients with a concomitant ischemic heart disease the cut-off value was 9.6 g/dl. 1. The average drop in hemoglobin levels associated with knee alloplasty was 3.5 g/dl. The volume of recovered blood used for post-operative autotransfusion was approx. 500 ml. 2. A low preoperative hemoglobin level is the most significant risk factor for heterologous blood transfusion. 3. Co-mordibities need to be taken into consideration when determining the amount of blood required.

Efficiency of Cardiotropic Therapy in Neonatal Infants with Posthypoxic Myocardial Damage

Objective: to define the optimal tranexamic acid dosage regimen to reduce perioperative blood loss during total endo-prosthetic hip joint replacement (TEHJR). Subjects and methods. A randomized controlled trial enrolled 90 patients admitted for elective primary cementless TEHJR. Prior to surgery, all the patients were given an intravenous bolus injection of tranexamic acid in a dose of 1 g. A day before surgery, the patients were divided into 3 groups of 30 subjects each. In Group 1, tranexamic acid was administered only before incision of the skin. In Group 2, a second bolus of tranexamic acid 1 g was injected 3 hours after start of surgery. In Group 3, 1 g of tranexamic acid was readminis-tered 6 hours following surgery if drainage blood loss volume exceeded 200 ml. Results. No statistically significant differences were found between the study patient groups in terms of the amount of blood loss, the blood levels of hemoglobin, needs for hemotransfusion therapy, and the frequency of postoperative complications. Conclusion. A second bolus of tranexamic acid 1 g does not reduce the amount of blood loss as compared to a single preoperative bolus dose of tranexamic acid 1 g during elective primary cementless TEHJP. Key words: tranexamic acid, endoprosthetic hip joint replacement, blood loss.

Blood Loss Control with Two Doses of Tranexamic Acid in a Multimodal Protocol for Total Knee Arthroplasty

Average blood loss after total knee arthroplasty (TKA) usually ranges from 1500 to 1900 cc, including both the postoperative drain and hidden blood loss. This represents about 46% of TKA patients requiring postoperative blood transfusion. Not only the risks of disease transmission but also those of ABO incompatibility, infection due to immunosupression, increased procedure costs, and increased length of hospital stay, are potential problems that foster blood saving strategies. In this study, 71 unilateral TKAs using a multimodal protocol to decrease blood loss were compared to 61 historical cases. Patients in both groups underwent cemented TKA with the same system, surgical technique, and multimodal protocol (MIS approach, plug in the femoral canal, tourniquet removal after wound closure and compressive bandage, analgesic periarticular infiltration with vasoconstrictor, postoperative drain at atmospheric pressure, opened 2 hours after the end of the surgical procedure and removed after 24 hours). The study series incorporated intravenous tranexamic acid (TXA) infusion in 2 doses of 10-15 mg/kg, 15 minutes before tourniquet release and 3 hours later. Results showed no transfusion requirements in the TXA series (0%), with 23/61 (37.7%) transfusions in the control, with an average cost decrease of 240 euros per patient. Visible bleeding in 24h significantly decreased from 553.36 cc (range 50-1500) to 169.72 cc (range 10-480) in the TXA series. As a conclusion, implementing a TXA-based multimodal protocol produced significant decrease in the transfusion rate, visible blood loss, and cost per patient, thus proving effectiveness and efficiency in the surgical management of TKA.

Platelet Aggregation Inhibitors, Platelet Function Testing, and Blood Loss in Hip Fracture Surgery

The purpose of our prospective study was to analyze how many patients with hip fractures are on treatment with platelet aggregation inhibitors (aspirin and clopidogrel), how many of these patients have impaired platelet function as measured by the PFA-100, and whether there is an association between perioperative blood loss and either intake of platelet inhibitors or platelet function. Four hundred sixty-two patients with hip fractures were investigated. Surgery (most commonly dynamic screw fixation and hemiarthroplasty) was performed on day 1.3 (in patients on clopidogrel on day 3). Platelet function analysis was performed with the PFA-100, using the collagen and epinephrine closure time. Transfusion requirement and drain blood loss were measured. Ninety-eight patients (21%) were on treatment with aspirin, of those, 64 patients (65%) had impaired platelet function. Twenty-two patients (5%) were on clopidogrel, of those, 15 patients (68%) had impaired platelet function. Of the patients without platelet aggregation inhibitors, 29% had impaired platelet function. Mortality, major bleeding, red blood cell requirement, and drainage blood loss did not correlate with platelet aggregation inhibitor intake or platelet function. It is not possible to predict the platelet function by asking patients about intake of aspirin or clopidogrel. Perioperative blood loss did not correlate with either history of platelet aggregation inhibitor intake or platelet function as determined by PFA-100. Therefore, the measurement of platelet function is of little clinical relevance in patients with hip fractures. In patients treated with aspirin, surgery should not be delayed, and patients on clopidogrel can be operated on 3 days after stopping the drug without increased bleeding risk.

Use of the Harmonic System in Total Hip Arthroplasty: A prospective, Comparative, Observational Study

We compared technical issues, postoperative outcomes and surgical complications of total hip arthroplasty when using the harmonic scalpel (HS) when compared with conventional techniques (CT) in a prospective, comparative observational study. Thirty patients undergoing total hip arthroplasty were assessed. Operative time, blood loss in drains, postoperative pain, soft tissue injury and complications were recorded. We found no significant differences between the HS and CT groups at baseline. Mean operative time was longer in the HS group compared with the CT of total hip arthroplasty (61 minutes vs. 54 minutes; P<0.05). We found no difference in postoperative pain using a visual analogue scale score, or use of paracetamol. The use of tramadol was reduced in the HS group compared to CT group at the 7th day (83.3 mg vs. 113.3 mg; P<0.05). Drainage volume was significantly lower in the HS group at 24 hours (332 ml vs. 429 ml; P<0.05) and at 48 hours (429 vs. 537 ml; P<0.05). C-reactive protein blood levels were significantly lower in the HS group 75 mg/l vs. 96 mg/l at the third day (P<0.05) and 26 mg /l vs. 54 mg /l at the seventh day (P<0.01). Creatine kinase blood levels were significantly lower in the HS group at 3 and 7 days (2.4 ukat/l compared to 5.3 ukat/l at the 3rd day (P<0.01), respectively 1.1 ukat/l compared to 1.8 ukat/l at the 7th day (P<0.01). We found no significant differences in blood myoglobin levels between the two groups. The use of the HS may reduce postoperative pain, drainage volume, and soft tissue injury in patients undergoing total hip arthroplasty, which may justify the cost of the technique. The use of HS may have further applications in revision hip arthroplasty and tumour surgery.

Effects of phosphorylcholine coating on extracorporeal circulation management and postoperative outcome: a double-blind randomized study

The aim of the study was to evaluate the effects of phosphorylcholine coating (PC) on intra-operative extracorporeal circulation (ECC) management and perioperative outcome. One hundred and twenty consecutive cardiac surgery patients were enrolled for the study. Patients were randomly assigned to ECC with PC circuits (60 patients) or to corresponding non-coated circuits (60 patients). Trans-oxygenator pressure drop, blood flows, flow resistances and ECC parameters were recorded at surgery before ECC institution and every 10 min thereafter until ECC discontinuation. Postoperative variables (hematological parameters, drainage blood loss, mechanical ventilation time, incidence of atrial fibrillation, use of blood products) were also assessed and compared between groups. No differences were found between the two groups in terms of demographics, operative, and hematological profiles. PC showed, at equal pump flows, to significantly (P<0.01) attenuate pressure drop across oxygenators and to reduce oxygenator inlet pressures during ECC. Postoperatively, PC showed to remarkably reduce platelet consumption. Coating showed also to reduce postoperative blood loss, although the difference did not reach statistical significance. No differences between the two groups were found in terms of additional perioperative effects. The use of PC in low-risk elective cardiac surgery patients enhances ECC management, by means of a less restrictive trans-oxygenator blood flow.

Impact of tranexamic acid vs. aprotinin on blood loss and transfusion requirements after cardiopulmonary bypass

Introduction: Aprotinin (AP) reduces blood loss and transfusions after cardiopulmonary bypass (CPB), but may sensitize patients and is expensive. Tranexamic acid (TA) has less side effects, but data regarding its efficacy are controversial. The aim of our prospective, randomized, double-blind study was to compare the impact of AP vs. TA on drainage blood loss and transfusion requirements in patients undergoing primary CABG on CPB. Methods: One hundred twenty adult patients were randomized to receive either high-dose AP according to Hammersmith or a total of 2g TA. Perioperative blood products were transfused in a standardized fashion. Blood loss was measured up to 24 hours. Demographic and clinical patient data were collected until hospital discharge. Results: The data from 118 patients (TA: n=58, AP: n=60) who completed the study according to protocol were analyzed. Blood loss at 24h postop in TA patients was significantly higher (896±354ml) as compared to AP patients (756±347ml; p=0.03). TA patients received 1.5±1.5 units red blood cells (AP: 1.5±1.7, p=1.0), 1.3±2.0 units fresh frozen plasma (AP: 1.0±2.0, p=0.38), and 0.5±1.4 units platelets (AP: 0.2±0.7, p=0.15). Clinical data including perioperative myocardial infarction rate, acute renal failure, mechanical ventilation, hospital stay, and mortality were not significantly different between both groups. Conclusion: Our data show a difference in blood loss between TA and high-dose AP. Although statistically significant, it has little clinical relevance, because perioperative transfusion requirements were similar for both groups. Thus, TA appears to be a cost effective alternative to AP in primary CABG patients.

Effects of celecoxib on blood loss, pain, and recovery of function after total knee replacement: A randomized placebo-controlled trial

Background Pain management after surgery has been used as a sales argument for the use of COX-2 inhibitors, but their potential positive and negative effects have not been fully investigated. We thus conducted a controlled evaluation of the effect of celecoxib on perioperative blood loss, pain relief and consumption of analgesics, range of motion, and subjective outcome in conjunction with total knee replacement (TKR).Method 50 patients were randomized to either placebo or celecoxib (200 mg) preoperatively and then twice daily. Total blood loss was calculated by the Hb balance method, taking the patient's pre- and postoperative hemoglobin and blood volume into account. Pain scores (VAS), range of motion, and subjective outcome (KOOS) were monitored postoperatively and during the first year after surgery.Results No differences in total, hidden, or drainage blood loss were found between the groups. There were 30% lower pain scores during the first 4 weeks after surgery and lower morphine consumption after surgery in the celecoxib group, while no effect was seen on pain, range of motion, and subjective outcome at the 1 year follow-up.Interpretation Celecoxib does not increase perioperative blood loss but reduces pain during the postoperative period after TKR. It is not necessary to discontinue celecoxib before surgery. The postoperative use of celecoxib did not increase range of motion or subjective outcome 1 year after TKR.

Efficacy and Safety of Tinzaparin Sodium as a Bridging Agent for Patients on Oral Anticoagulant Undergoing General Surgery: Clinical Experience with the First 100 Consecutive Patients.

The aim of the present prospective study was to test the efficacy and safety of a bridging protocol in patients under oral anticoagulants (OA) who need to undergo general surgery. One hundred consecutive patients receiving oral anticoagulant accenocoumarol for various cardiovascular disorders entered the study. Patients underwent 107 scheduled operations (among them 41 cholecystectomies, 24 colectomies, 13 hernia repairs and 9 ERCPs, the 7 followed by cholecystectomy), receiving the low molecular weight heparin (LMWH) tinzaparin sodium as the bridging agent. At least 4 days prior to the operation the OA was replaced with tinzaparin at a daily dose of 175 anti-Xa IU per kg of body weight. Patients received no LMWH on the day of the operation and the OA was co-administered with tinzaparin on the second post-operative day and for at least 2 days. When target INR (2.5 to 3) was achieved, tinzaparin administration was stopped. Lower limbs color duplex was performed pre-operatively and on the 2nd, 8th–10th and 20th–30th post-operative day. Complete anticoagulation profile, intra-operative bleeding and post-operative blood loss, large haematoma development (over 5 cm in diameter), deep vein thrombosis (DVT) and 30-day morbidity and mortality were thoroughly recorded. During the 30-day period 1 patient died (from sepsis), 9 developed wound infections and three underwent re-operations (two for anastomotic leaks and one for duodenal perforation following ERCP). None of these events was related to the bridging process. There were no proximal DVTs. Three asymptomatic distal vein thromboses (2 posterior tibial and one peroneal ) were identified on post-operative duplex scan. No large wound haematomas were seen. One colorectal surgery patient had a drain blood loss of 460 ml on the first and 140 ml on the second post-operative day, requiring blood transfusion; tinzaparin administration was delayed for three days in this case. Finally, in 17 cases we had difficulties in adjusting INR levels to the desired range; in these cases tinzaparin administration was prolonged for 2–5 days. We conclude that our bridging protocol, using therapeutic doses of the LMWH tinzaparin sodium as the bridging agent, is both safe and effective for replacing OAs in patients undergoing general surgery operations.

P10 Transfusion‐Related Cost of Aprotinin in Scoliosis Surgery for Children and Adolescents.

Introduction Scoliosis surgery causes major blood loss. Previous research has demonstrated that aprotinin reduces perioperative blood loss and thus transfusion. To date there has not been a cost analysis of the effect of aprotinin on transfusion requirement in scoliosis surgery.Methods Retrospective case series of all patients &lt;18 years old at the time of their scoliosis surgery. All patients were operated on and anaesthetised by the same consultant surgeon and anaesthetist between May 2002 and February 2006. Estimated blood volume (EBV) was 70 mL kg−1. Postoperative care was on the Paediatric Intensive Care Unit (PICU) or Spinal High Dependency Unit (HDU). The anaesthetic chart and cell salvage audit form recorded intra‐operative blood loss. The PICU/HDU charts recorded postoperative drain blood loss for the first 24 h. Aprotinin was given as a bolus prior to the start of surgery followed by an infusion until wound closure. Cost data for allogeneic blood products, autologous blood collection/processing and aprotinin were collected from the start of surgery until 24 h postoperatively. The analysis used current tariffs. Other consumables and drugs were excluded. Comparisons between groups were made using unpaired t tests.Results A total of 27 patients were reviewed. Fifteen patients received aprotinin and 12 did not. Intra‐operative cell salvage was used for all patients. Two thirds of the patients in each group were at high risk of major blood loss due to neuro‐muscular disease. The groups (aprotinin versus no aprotinin) were comparable for age (mean ± SD) 13 ± 2.8 versus 14 ± 2.7 years, weight 50.9 ± 16.9 versus 51.2 ± 30.4 kg, surgical time 254 ± 58.8 versus 286 ± 109.6 min and vertebral levels fused (median + interquartile range) 15 (10–16) versus 14.5 (8.5–16). Mean aprotinin bolus dose was 21.14 ± 10.91 kiU kg−1 and mean aprotinin infusion rate was 7.17 ± 2.44 kiU kg−1 h−1. The median transfusion‐related cost of aprotinin was £638.02 (£319.73–£1010.60) compared to £1086.00 (£423.42–£1476.01)(P = 0.107) without aprotinin, equating to a relative cost saving of 41.2%. Total peri‐operative blood loss (as a fraction of EBV), in the aprotinin group was 0.66 ± 0.40 EBV versus 1.25 ± 1.06 EBV(P = 0.09). Median units of blood product transfused in the aprotinin and no aprotinin groups were; blood 1 ( 0–2.5) versus 2.5 (1–5.25) (P = 0.06), fresh frozen plasma 2 (1–2.5) versus 2 (2.3–3.25) (P = 0.07), cryoprecipitate bags 0 (0–0) versus 0 (0–2) (P = 0.16), platelets 0 (nil given) versus 0 (0–1) (P = 0.07).Conclusions The reduction in peri‐operative blood loss and thus transfusion requirements associated with aprotinin has translated to a cost reduction. A small sample size has prevented the cost analysis from reaching statistical significance. As blood products become more scarce and costly, blood preservation techniques will become increasingly vital.

Impact of tranexamic acid vs. aprotinin on blood loss and transfusion requirements after cardiopulmonary bypass: a prospective, randomised, double-blind trial

SummaryIntroduction: Aprotinin (AP) reduces blood loss and transfusions after cardiopulmonary bypass (CPB), but may sensitise patients and is expensive. Tranexamic acid (TA) has less side-effects, but data regarding its efficacy are controversial. The aim of our prospective, randomised, double-blind study was to compare the impact of AP vs. TA on drainage blood loss and transfusion requirements in patients undergoing first time CABG on CPB.Materials and Methods: One hundred and twenty adult patients were randomised to receive either high-dose AP according to Hammersmith or a total of 2 g TA. Perioperative blood products were transfused in a standardised fashion. Blood loss was measured up to 24 h. Demographic and clinical patient data were collected until hospital discharge.Results: The data from 118 patients (TA: n = 58, TA appears to be a cost-effective alternative to AP AP: n = 60) who completed the study according to protocol were analysed. Blood loss at 24 h postoperation in TA patients was significantly higher (896 ± 354 ml) as compared to AP patients (756 ± 347ml; p = 0.03). TA patients received 1.5 ± 1.5 units of red blood cells (AP: 1.5 ± 1.7, p = 1.0), 1.3 ± 2.0 units of fresh frozen plasma (AP: 1.0 ± 2.0, p = 0.38) and 0.5 ± 1.4 units of platelets (AP: 0.2 ± 0.7, p = 0.15). Clinical data, including perioperative myocardial infarction rate, acute renal failure, mechanical ventilation, hospital stay and mortality, were not significantly different between either group.Conclusion: Our data show a difference in blood loss between TA and high-dose AP. Although statistically significant, it has little clinical relevance, because perioperative transfusion requirements were similar for both groups. Thus, TA appears to be a cost-effective alternative to AP in primary CABG patients.

Early and medium-term results after on-pump and off-pump coronary artery surgery: a propensity score analysis

Background Comparative publications on beating-heart off-pump coronary artery bypass grafting (OPCAB) surgery versus conventional coronary artery bypass grafting (CCAB) surgery frequently do not offer conclusive information because of investigator bias. Methods Trying to eliminate this problem, a propensity score analysis of the data of all CCAB patients (n = 517) and OPCAB patients (n = 133) operated on by the same surgeons during the same time period (1998 to 2001) was applied. After matching patients with similar propensity score values, 97 CCAB patients and 72 OPCAB patients entered the final analysis. Results Early results were similar in both groups: the 30-day mortality reached 1.4% in the CCAB group and 2.8% in the OPCAB group; strokes did not happen. Perioperative myocardial infarctions occurred in 4.1% of the CCAB patients and 4.3% of the OPCAB patients. Drainage blood loss in the first 24 hours after surgery (830 ± 687 mL, CCAB group; and 909 ± 678 mL, OPCAB group) was similar ( p = 0.06) in both groups. Medium term results (freedom from percutaneous transluminal coronary angioplasty or reoperation, freedom from myocardial infarction, freedom from stroke, and the quality of life) also were not significantly different between the off-pump and on-pump groups after a mean follow-up of 27 ± 11 months. Conclusions Our results suggest that elective-surgery patients with coronary artery disease can be operated on either on-pump or off-pump with the same early and late mortality and morbidity.

Impact of hematocrit value after coronary artery surgery on perioperative myocardial infarction rate.

The optimal hematocrit (HCT) value after coronary artery bypass grafting on cardiopulmonary bypass (CPB) has not yet been established. The purpose of our retrospective study was to investigate the association between HCr at the time of entry into the ICU and perioperative Ml rate. We reviewed the charts of 500 consecutive coronary artery surgery patients with respect to biometric data, operative procedure, aprotinin or tranexamic acid use, perioperative drainage blood loss and transfusion requirements, perioperative Ml, ICU stay and hospital mortality. Perioperative Ml was defined as new Q-wave on ECG and CK-MB 250U/I. Patients were categorized into three groups depending on their HCr value at the time of entry into the ICU: low (HCTcu 27%): medium (HCr,cu 28% to 32%); high(HCTrcu > or =33%). Age, gender distribution, preoperative LV function, and previous Ml rate were similar between the three groups. Low HCT patients (n -133) received 3.1 +/- 1.0 (Mean + SD) grafts during 55 +/- 19 minutes aortic cross clamp time, 98 +/- 31 minutes on CPB (medium HCT: n = 257; 3.2 +/- 1.0 grafts, 51 +/- 20 min cross clamp time, 93 +/- 30 min CPB; p - 0.45 vs. low HCT; high HCT: n = 110: 3.3 +/- 1:0 grafts; 53 +/- 20 min cross clamp time; 104 +/- 38 min CPB; p = 0.02 vs. medium HCT). The perioperative Ml rate was 3.8% in the low, 4.3% in the medium, and 6.4% in the high-HCr group (p =0.59 ). Intraoperative red blood cell and fresh frozen plasma transfusions were similar between the groups. In the low-HCa group, 53.4% of the patients received aprotinin during the procedure (medium HCa: 65.4%; high HCT: 77.3%; p<0.001). Drainage blood loss during the first 24 hours on ICU was 834 +/- 453 ml in the low, 757 +/- 485 ml in the medium (p -0.44 vs. low), and 640 +/- 353 ml in the high-HCr group (p = 0.003 vs. low). Postoperative red blood cell and fresh frozen plasma transfusions were highest in the low-HCa group(p<0.001). ICU stay was similar between the groups. Hospital mortality was 0.75% in the low, 1.9% in the medium, and 4.5%in the high-HCa group (p = 0.12). In this retrospective analysis of 500 consecutive coronary artery surgery patients, we did not find any association between perioperative Ml rate and HCr value on entry into the ICU. These results do not support the recent suggestion that low HCT at the time of entry into the ICU protects against perioperative Ml.

Clinical effects of the heparin coated surface in cardiopulmonary bypass

In a randomised study of 120 patients, undergoing primary operation for coronary heart decease, two groups were investigated as regards to the effects of heparin coated cardiopulmonary bypass on brain function parameters and general clinical outcome. The study group (n = 56) was perfused using an extra-corporeal circuit treated with covalent bonded heparin; the control group (n = 59) used an identical set-up without heparin treatment. Systemic heparin doses were calculated to achieve ACT levels of 250 and 500 s, respectively. Postoperative course was evaluated by examining a set of clinically relevant parameters including a detailed registry of postoperative deviations. Brain function was assessed by the biochemical marker S-100 and tests of memory performance.There were several signs of reduced operative trauma in the study group. Hospital stay was reduced by nearly 1 day (P < 0.05). Time on postoperative ventilatory support was approximately 4 h shorter (P = 0.009). Chest drain blood loss was decreased both at 8 (P = 0.01) and 24 h (P = 0.007) postoperatively. Body temperature was lower after surgery and especially on days 2 (P = 0.03) and 3 (P = 0.01). Perioperative creatinine elevation was significantly reduced (P = 0.03). Neurological deviations were fewer (P = 0.01). Brain function assessment revealed reduced plasma levels of S-100 both at termination of cardiopulmonary bypass (P = 0.008) and 7 h later (P = 0.04). However, no remediation of memory impairment could be demonstrated.Cardiopulmonary bypass with covalent bonded heparin attached to the extra-corporeal circuit in combination with a reduced systemic heparin dose seems to reduce safely and effectively the operative stress to the patient. There were also signs of improved cerebral protection.

Clinical effects of the heparin coated surface in cardiopulmonary bypass

In a randomised study of 120 patients, undergoing primary operation for coronary heart decease, two groups were investigated as regards to the effects of heparin coated cardiopulmonary bypass on brain function parameters and general clinical outcome. The study group (n = 56) was perfused using an extra-corporeal circuit treated with covalent bonded heparin; the control group (n = 59) used an identical set-up without heparin treatment. Systemic heparin doses were calculated to achieve ACT levels of 250 and 500 s, respectively. Postoperative course was evaluated by examining a set of clinically relevant parameters including a detailed registry of postoperative deviations. Brain function was assessed by the biochemical marker S-100 and tests of memory performance. There were several signs of reduced operative trauma in the study group. Hospital stay was reduced by nearly 1 day (P < 0.05). Time on postoperative ventilatory support was approximately 4 h shorter (P = 0.009). Chest drain blood loss was decreased both at 8 (P = 0.01) and 24 h (P = 0.007) postoperatively. Body temperature was lower after surgery and especially on days 2 (P = 0.03) and 3 (P = 0.01). Perioperative creatinine elevation was significantly reduced (P = 0.03). Neurological deviations were fewer (P = 0.01). Brain function assessment revealed reduced plasma levels of S-100 both at termination of cardiopulmonary bypass (P = 0.008) and 7 h later (P = 0.04). However, no remediation of memory impairment could be demonstrated. Cardiopulmonary bypass with covalent bonded heparin attached to the extra-corporeal circuit in combination with a reduced systemic heparin dose seems to reduce safely and effectively the operative stress to the patient. There were also signs of improved cerebral protection.

Low-molecular-weight heparin (enoxaparin) vs dextran 70. The prevention of postoperative deep vein thrombosis after total hip replacement. The Danish Enoxaparin Study Group

A prospective randomized study compared the thromboprophylactic efficacy and safety of a low-molecular-weight heparin (LMWH), enoxaparin (40.6 mg subcutaneously once daily), with a standard regimen of dextran 70 in patients undergoing elective total hip replacement. Deep vein thrombosis was diagnosed by bilateral ascending phlebography 7 to 11 days after operation. Two hundred forty-six patients were included and 219 were eligible for analysis. Deep vein thrombosis was diagnosed in seven of 108 patients in the LMWH group and in 24 of 111 patients in the dextran group. Clinical symptoms of pulmonary embolism did not develop in any patients during the study. In the postoperative period, patients receiving LMWH had a lower blood loss in drains and required fewer blood transfusions than patients receiving dextran, although no significant differences were noted between the groups with respect to the total number of blood transfusions required. Bleeding events and adverse events did not differ between the groups. None of the patients died in hospital during the study. One patient in the LMWH group died at home 15 days after the operation. Three patients receiving dextran had development of symptomatic deep vein thrombosis after hospital discharge. In conclusion, enoxaparin was a more effective thromboprophylactic than a standard regimen of dextran in patients undergoing total hip replacement. The two regimens were equally safe under the clinical conditions.

Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion.

We prospectively studied the cases of 121 patients who were being operated on for insertion of a unilateral total knee prosthesis with cement, and we placed them randomly in four groups. In Group I, the tourniquet was inflated throughout the operative procedure, and we released it postoperatively after a compressive dressing had been applied; a splint was used postoperatively for three days. In Group II, the tourniquet remained inflated throughout the operation, but no splint was applied postoperatively, and continuous passive motion was started immediately in the recovery room. In Group III, the tourniquet was released intraoperatively, and hemostasis was achieved by cauterization; postoperatively, a compressive dressing was applied, and a splint was used for three days. In Group IV, the tourniquet was released intraoperatively, hemostasis was established, and then the tourniquet was reinflated; a compressive dressing was applied, and continuous passive motion was started immediately in the recovery room. Hemoglobin and hematocrit values were monitored in all patients. Blood loss in suction drainage was recorded, and the total blood loss was calculated. The results show that total knee arthroplasty is associated with major loss of blood (mean, 1518 milliliters). The calculated blood loss for Groups I, II, and III averaged 1443 milliliters, while that for Group IV averaged 1793 milliliters. Loss in suction drainage correlated with total estimated blood loss and averaged 511 milliliters. The magnitude of blood loss after total knee arthroplasty should be appreciated, and special attention should be paid to the availability of adequate fluid and blood products, preferably blood donated by the patient preoperatively.

Postoperative use of continuous passive motion, transcutaneous electrical nerve stimulation, and continuous cooling pad following total knee arthroplasty

Three rehabilitation modalities relating to in-hospital postoperative care following unilateral total knee arthroplasty (UTKA) were studied regarding their effect on pain management and UTKA outcome: (1) continuous passive motion (CPM); (2) CPM with transcutaneous electrical nerve stimulation (TENS); and (3) CPM with continuous cooling pad (CCP). Phase I: CPM. Twenty-two UTKA patients were randomized into two postoperative care groups: (1) 12 with CPM; and (2) 10 with no CPM. Total hospitalization pain medication consumption was significantly less for the CPM group ( P < .05). Phase II: CPM With TENS. Forty-eight UTKA patients were randomized into three postoperative care groups: (1) 18 with an ipsilateral thigh TENS unit delivering sensory threshold stimulation; (2) 18 with a subthreshold TENS unit; and (3) 12 with no TENS unit. All groups used CPM. No significant difference was found regarding pain medication consumption. Phase III: CPM With CCP. Thirty consecutive UTKA patients were divided into two postoperative care groups: (1) 15 with a CCP unit; and (2) 15 with no CCP unit. Both groups used CPM. No significant difference was found regarding total or intramuscular hospitalization pain medication consumption. However, oral hospitalization pain medication consumption was significantly less for the CCP group ( P < .01). This postoperative UTKA study demonstrates significantly decreased total in-hospital pain medication consumption when comparing CPM vs no CPM, significantly decreased oral in-hospital pain medication consumption when comparing CPM with CCP vs CPM without CCP, but no difference when comparing CPM with TENS vs CPM without TENS. No significant difference in UTKA outcome (postoperative drain blood loss, hospitalization duration, or range of motion) was shown for any of the comparison groups.