Difference In Postoperative Hemoglobin Research Articles

Anatomical study of perigastric fascial space and guidance for laparoscopic approach.

To study the anatomic characteristics of gastric peritoneum fascia space and provide a safe surgical approach for laparoscopic radical gastrectomy. The morphological characteristics of perigastric fascia and fascial space and the course of important blood vessels were observed and studied in 2 fresh adult cadavers, 5 formalin immersed cadavers and 56 patients undergoing total gastrectomy. The hemoglobin, albumin, prealbumin, total protein, operation time, intraoperative blood loss, number of lymph node dissection and the incidence of complications before and after laparoscopic total gastrectomy with different approaches were statistically analyzed. Through dissecting the cadaver, it is found that the space of the posterior gastric fascia space is suitable for laparotomy and laparoscopic surgery. The space between the prepancreatic fascia and the posterior gastric fascia is located in a plane, and the posterior gastric fascial space is connected with the gastrosplenic space and hepatogastric space. Through three different plane approaches, all can enter the space without blood vessels and nerves, so as to achieve complete gastrectomy. Statistical analysis of patients undergoing total gastrectomy with different approaches showed that there was no significant difference in operation time, intraoperative blood loss, number of lymph node dissection and postoperative complications among the three approaches (P > 0.05). There was no significant difference in postoperative hemoglobin, albumin, prealbumin and total protein (P > 0.05). The space of the posterior gastric fascia space is suitable for laparotomy and laparoscopic surgery.the application of the anatomical study of perigastric fascial space in laparoscopic radical resection of gastric cancer not only accords with the tumor-free principle of radical resection of tumor, improves the safety of operation, but also reduces the occurrence of complications such as bleeding and important organ injury.

Vaginal natural orifice transvaginal endoscopic surgery (vNOTES) for benign ovarian cysts is safe and feasible in same-day discharge: a retrospective cohort study

BackgroundAdvances in minimally invasive surgery and the development of Enhanced Recovery After Surgery (ERAS) have favored the spread of day-surgery programs. Even though Vaginal natural orifice transvaginal endoscopic surgery (vNOTES) is accepted as an innovative treatment for benign ovarian cysts that is rapidly gaining recognition worldwide, the safety and feasibility of same-day surgery (SDS) have yet to be established.ObjectiveThis study aimed to evaluate the safety and feasibility of day surgery compared to inpatient surgery of patients undergoing vNOTES for benign ovarian cysts by determining perioperative outcomes.Materials and methodsThe study consisted of 213 patients who underwent vNOTES for ovarian cystectomy at a single institution from January 2020 to November 2022. Based on the hospital stay, patients were classified into the same-day surgery group (SDSG) and the inpatient surgery group (ISG); after data processing and screening considering the balance of the two groups, SDSG has 83 samples(n = 83), and ISG has 113 samples(n = 113). The patient’s demographic characteristics and follow-up data were collected during the perioperative period by doctors and nurses for medical tracking and analysis purposes and 1-month postoperatively by doctors in charge of their operation. Independent sample t-tests were performed to verify if there was any major difference between these two groups for continuous data like age, BMI, and cyst diameter, and Pearson’s chi-squared tests were used to test whether there was a major difference between these two groups for categorical data like cyst count, abdominal surgery history and whether their cyst is bilateral ovarian cysts or not. The association between exhaust time and postoperative characteristics and the association between levels of pain and postoperative characteristics were further analyzed to unveil the confounding factors contributing to the same-day discharge method’s quick recovery nature.ResultsUpon performing propensity score matching, 196 patients were finally enrolled in this study for the matched comparison, including 83(42.3%) patients in the SDSG and 113(57.7%) patients in the ISG. There was no statistical difference between the two groups in terms of duration of operation (85.0 ± 41.5 min vs. 80.5 ± 33.5 min), estimated blood loss (27.7 ± 28.0 ml vs. 36.3 ± 33.2 ml), preoperative hemoglobin levels (128.8 ± 13.2 g/L vs. 128.6 ± 14.0 g/L), postoperative hemoglobin difference at 24 h (16.5 ± 15.4 g/L vs. 19.3 ± 9.1 g/L), pelvic adhesions (42 (50.6%) vs. 47 (41.6%)), and postoperative complications (7(8.4%) vs. 4(3.5%)). The SDSG group showed less time of feeding/off-bed/exhaust/urination after surgery, shorter hospitalization duration, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use. Multiple linear regression analysis showed that advancing the time of postoperative off-bed activity and feeding reduced the postoperative exhaust time by 0.34 (95% CI: 0.185–0.496, 0.34 h, p < 0.001) and 0.299(95% CI: 0.158–0.443, 0.229 h, p = 0.036) hours. In addition, Ordinal logistic regression revealed a correlation between pain scores and bilaterality of cyst, increasing about 25.98 times the risk of pain levels when ovarian cysts are bilateral (OR: 26.98, 95% CI: 1.071–679.859, P = 0.045).ConclusionIn this pilot study, same-day discharge after vaginal natural orifice transvaginal endoscopic ovarian cystectomy is safe and feasible. The vNOTES for ovarian cystectomy combined with the same-day discharge shorten the exhaust time and duration of hospitalization, reduce postoperative pain, and lower the use incidence of analgesic drugs.

Comparative Study of Reducing Blood Loss in Total Knee Replacement with and without the Use of Tranexamic Acid, Tourniquet, and Drainage

Background: Patients who undergo total knee arthroplasty (TKA) may develop large blood loss. The intraoperative and postoperative blood loss after TKA ranges from 1500 to 1900 cc. TKA is often carried out using a tourniquet and drains to collect the shedded blood loss. However, tranexamic acid is found to decrease blood loss. Tranexamic acid is a fibrinolysis inhibitor that blocks the plasminogen, and it has been reported before that it reduces blood loss in patients undergoing TKA. However, few reports describe the effects of tranexamic acid on blood loss in patients who underwent TKA. Objectives: To study the reduction of blood loss after intravenous tranexamic acid infusion in patients undergoing TKA without the use of tourniquets or drains. Patients and Methods: We performed a total of 95 TKA in osteoarthritis patients between 2017-2018. A total of 30 patients were operated during 2017 and at that time tourniquets with drains were used with no intravenous tranexamic acid. On the other hand, a total of 45 patients were operated in the year 2018 and for those intravenous tranexamic acid was used to decrease the blood loss without the use of tourniquets or drains. For those who received tranexamic acid it was given as follows, at time of anesthesia induction a total of 1 gram tranexamic acid is infused over 10 min. At closure, another 1 gram tranexamic acid is infused over 10 min. Furthermore, Patient's demographics, preoperative and postoperative hemoglobin (Hb) levels were studied as well as the need for blood transfusion between the two groups. Results: The two groups had similar characteristics. The mean of pre and postoperative hemoglobin difference was 2.9 (SD 1.0) and 3.5 (SD 1.23) in the tourniquets and tranexamic acid groups respectively (p value = 0.041). However, postoperatively 5 (16.6%) of the tourniquets group received blood transfusion. Whereas, no one (0%) of the tranexamic acid patients needed to receive blood (p value = 0.005). Conclusion: The use of tranexamic acid may decrease the total blood loss in patients undergoing TKA. Furthermore, there is less need for blood transfusion in those who received tranexamic acid

Mini Percutaneous Nephrolithotomy vs Standard Percutaneous Nephrolithotomy: A Perioperative Decision Support System for Surgical Success Comparison.

This study aimed to rank the features that are important in terms of safety and effectiveness in choosing the surgical method and providing appropriate care to the patient by using the variables examined before and after the surgery to evaluate the success of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy surgeries. The features evaluated before and after surgery were ranked according to their importance in the features considered, using Multivariate Adaptive Regression Splines (MARS), LASSO, Ridge, Elastic_net, and Random Forest algorithms as variable selection techniques. There are 278 samples in the relevant data set. Type of surgery (100%), intercostal access (97.75%), kidney opening procedure (94.25%), postoperative creatinine (59.22%), hydronephrosis (52.23%), the number of entries (41.61%), and pre- and post-operative hemoglobin difference (45.13%) were determined as the most critical variables. The MARS algorithm showed the most successful performance, with the lowest mean absolute error (MAE) value of 0.3622, the lowest root mean square error (RMSE) value of 0.3960, and the highest R2 value of 0.3405. Clinical decision support systems can be helpful in eliminating errors and reducing costs. It can also improve the quality of healthcare and aid in the early diagnosis of diseases. Computer-aided decision-making systems can be developed using the results of such products. These systems can provide doctors with better information about their patient's treatment options and improve decision-making. It can contribute to patients being better informed about the surgery results and taking an active role. In conclusion, this study provides essential information that should be included in the surgical decision-making process for patients using medications and with a history of percutaneous nephrolithotomy.

Tranexamic acid usage in hip fracture surgery: a meta-analysis and meta-regression analysis of current practice

The use of tranexamic acid (TXA) in hip fracture surgery remains inconclusive. The aim of the present meta-analysis was to assess the role of TXA use in hip fracture surgery, and attempt to disclose possible factors which might influence TXA efficacy and safety. A systematic computerized literature search was conducted to retrieve all randomized controlled trials (RCTs) and cohort studies regarding TXA use in hip fracture surgery. Overall efficacy and safety were evaluated. Then, subgroup and meta-regression analyses were conducted to disclose the influence of geographic area, fracture type, administration route, frequency and dosage of TXA, blood transfusion threshold, and follow-up duration on the overall effect. Thirty-four RCTs and 11 cohort studies were included. Patients receiving TXA had a significant decrease in the need for blood transfusion, reduced total, intra-operative and post-operative blood loss, a decrease in pre- and postoperative hemoglobin difference, without increasing thromboembolic events risk. Subgroup analysis showed that topical TXA had a lower transfusion rate compared with controls, yet the result did not reach statistical significance. Also, TXA had similar efficacy and safety profiles in patients with different frequency and dosage of TXA. Current evidence indicated that intravenous administration of TXA could significantly reduce blood transfusion and blood loss without increasing risk of thromboembolic events. The frequency and dosage of TXA might not alter the beneficial effect. The application of topical TXA should be cautious.

Efficacy of intraoperative cell salvage in spine surgery: a meta-analysis.

Intraoperative cell salvage systems, or cell savers, are widely used for the management of blood loss in patients undergoing spine surgery. However, recent studies report conflicting evidence of their efficacy. The purpose of the meta-analysis was to investigate the efficacy of cell savers in reducing blood transfusion requirements in patients undergoing spine surgery. Both retrospective and prospective studies that investigated the efficacy of cell savers in reducing transfusion requirements in spine surgery patients when compared with control patients were identified from MEDLINE, Embase, Cochrane Collaboration Library, Google Scholar, and Scopus databases. Outcome data extracted included number of patients receiving allogenic transfusions (transfusion rate); units of allogenic transfusions; postoperative hemoglobin; costs; operative time; and complications. RevMan 5 software was used to perform statistical analyses. A random-effects model was used to calculate pooled odds ratios (with 95% CIs) and weighted mean differences (WMDs [95% CI]) for dichotomous and continuous variables, respectively. Eighteen studies with 2815 patients in total were included in the meta-analysis. During spine surgery, the use of intraoperative cell salvage did not reduce the intraoperative (OR 0.66 [95% CI 0.30, 1.41]), postoperative (OR -0.57 [95% CI 0.20, 1.59]), or total transfusion (OR 0.92 [95% CI 0.43, 1.98]) rate. There was a reduction in the number of allogenic units transfused intraoperatively by a mean of 0.81 (95% CI -1.15, -0.48). However, there were no differences in the number of units transfused postoperatively (WMD -0.02 [95% CI -0.41, 0.38]) or the total units transfused (WMD 0.08 [95% CI -1.06, 1.22]). There were also no differences in operative time (WMD 19.36 [95% CI -2.43, 42.15]) or complications reported (OR 0.79 [95% CI 0.46, 1.37]) between groups. A difference in postoperative hemoglobin (WMD 0.54 [95% CI 0.11, 0.98]) between both groups was observed. Cell saver is efficacious at reducing intraoperative allogenic units transfused. There is no difference in transfusion rates, postoperative units transfused, and the total number of units transfused. Further cost analysis studies are necessary to evaluate the cost-effectiveness of this method of blood conservation.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: meta-analysis; strength of recommendation: low.

Should synovectomy be performed in primary total knee arthroplasty for osteoarthritis? A meta-analysis of randomized controlled trials

BackgroundDuring primary total knee arthroplasty (TKA), synovectomy as a part of the procedure has been recommended to relieve pain and inflammation of the synovium, but there is a controversy about it due to increased bleeding. In this meta-analysis, the aim is to answer whether synovectomy should be performed routinely during TKA for symptomatic knee osteoarthritis (KOA).MethodsRelevant randomized controlled trials (RCTs) on synovectomy were retrieved through database searches of PubMed, Embase, Web of Science, and Cochrane Library up to February 2019. Studies that compared postoperative pain, clinical Knee Society Score (KSS), functional KSS, range of motion (ROM), drainage, pre- and postoperative hemoglobin difference, transfusion rate, operative time, and/or complications were included in the meta-analysis. Review Manager 5.3.0 was used for meta-analysis.ResultsWe included 5 RCTs with 542 knees. Pooled results indicated that the synovectomy group was associated with more blood loss via drainage (WMD = − 99.41, 95% CI − 153.75 to − 45.08, P = 0.0003) and pre- and postoperative hemoglobin difference (WMD = − 0.93, 95% CI − 1.33 to − 0.5, P < 0.00001), compared with the non-synovectomy group. No statistically significant differences were demonstrated between both groups in postoperative pain, clinical KSS, functional KSS, ROM, transfusion rate, or complications (P > 0.05).ConclusionsThe current evidence demonstrates that performing synovectomy in primary TKA for symptomatic KOA does not have any clinical benefit. It increases postsurgical blood loss. Surgeons routinely undertaking synovectomy should deliberate whether this is clinically indicated and consider limiting resection, if possible.

The occurrence and clinical significance of contrast agent spillover on immediate enhanced CT reexamination after radiofrequency ablation of liver cancer

Objective: To investigate the relationship between radiofrequency ablation immediately after enhanced CT scanning and the occurrence of contrast agent spillover and postoperative severe bleeding, and analyze the risk factors for hepatocellular carcinoma (HCC). Methods: A retrospective analysis of 199 patients with hepatocellular carcinoma who underwent radiofrequency ablation of liver cancer in our hospital from January 2016 to January 2017 was reviewed. A total of 232 cases were treated with ablation. The agent spillovers were divided into two groups, one for the contrast agent spill group and the other for the non-contrast agent spill group. Its basic clinical data, laboratory data related to the risk of bleeding, and imaging data were analyzed to explore their clinical treatment effects and the risk factors for their occurrence. According to different data, t-test, χ2 test or logistic regression test was used for statistical analysis. Results: In 199 patients, a total of 232 cases were treated with ablation, including 138 males and 61 females. The average age was (57.56 ± 12.09) years and the average diameter of lesions was (3.42 ± 2.30) cm. A total of 30 cases (12.93%) of contrast agent spillover occurred immediately after the ablation of CT scanning needle. There were no severe bleeding and no special clinical intervention after the operation. The other 202 cases were non- contrast agent spill group, but 2 cases had severe bleeding and had corresponding clinical interventions. Univariate analysis showed that there were statistically significant differences in thoracentesis (P = 0.019), complications of cirrhosis (P < 0.001), and histological types of liver cancer (P = 0.013), and other clinical data [age, lesion size]. There were no significant differences in Child-Pugh classification, preoperative hemoglobin (HGB), platelet count, prothrombin time, APTT, international standardized ratio, number of puncture needles, and puncture length. There was also no significant difference in postoperative HGB (P = 0.160), preoperative-postoperative HGB change (P = 0.999), and length of hospital stay (P = 0.730) between the two groups. Logistic regression analysis showed that with cirrhosis (OR = 5.59, P < 0.001), transthoracic puncture (OR = 2.67, P = 0.021) may be a risk factor for contrast agent spillover after CT-enhanced CT scan in patients with hepatocellular carcinoma. Conclusion: Contrast agent spillover is not uncommon in the evaluation of curative effect of CT immediately after ablation (12.93%). It is not predictive for the occurrence of postoperative severe bleeding and does not require excessive clinical intervention. Liver cirrhosis and transthoracic cavity puncture may be the risk factors for its occurrence. The risk of severe postoperative bleeding should not be ignored for patients who have no contrast agent spills after surgery.

Outcome of 980 nm diode laser vaporization for benign prostatic hyperplasia: A prospective study.

PurposeTo evaluate the initial experience and outcome of photo-selective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) in Pakistan with the use of a 980 nm diode laser.Materials and MethodsA prospective study was performed from November 2016 to December 2017. A total of 100 patients diagnosed with bladder outlet obstruction secondary to BPH who planned for PVP were enrolled in the study. PVP was carried out with a diode laser at 980 nm (Biolitec Diode 180W laser) in a continuous wave with a 600 nm (twister) fiber. Baseline characteristics and perioperative data were compared. Postoperative outcomes were evaluated by International Prostate Symptom Score (IPSS), post void residual (PVR) and maximum urinary flow rate (Qmax) at 3 and 6 months after surgery.ResultsThe mean age was 65.82±10.42, mean prostate size was 67.35±16.42, operative time was 55.85±18.01 and total energy was 198.68±49.12 kJ. At 3 months and 6 months, significant improvements were noted (p<0.001) in IPSS 7.04±1.69 (−18.92), Qmax 19.22±4.75 mL/s (+13.09) and and PVR 18.89±5.39 mL (−112.80). Most frequent problems were burning micturition (35%) and terminal dysuria (29%). No significant difference in postoperative hemoglobin was seen in patients who were on anti-platelet drugs.ConclusionsPVP with a diode laser is a safe and effective procedure for the treatment of BPH and is also safe in patients who are on anti-platelet agents.

Perioperative Outcomes of 3-Arm Versus 4-Arm Robotic Radical Hysterectomy in Patients with Cervical Cancer

Study ObjectiveTo investigate and compare surgical outcomes of the 3 versus 4 robotic arm approaches for robotic surgery in patients with cervical cancer. DesignA retrospective analysis of prospectively collected data (Canadian Task Force classification II-2). SettingAn academic tertiary hospital. PatientsA total of 142 patients with stage 1A1 to IIB cervical carcinoma who underwent robotic surgery were included for analysis. The subjects were divided according to the surgical approach (i.e., the number of robotic arms), and the 2 groups were compared in terms of intraoperative data and postoperative outcomes. InterventionsRobotic radical hysterectomy (RRH) with lymphadenectomy using 3 robotic arms (n = 101) versus 4 robotic arms (n = 41). Measurements and Main ResultsPerioperative surgical outcomes. The 3-arm robotic approach consisted of a camera arm, 2 robotic arms, and 1 conventional assistant port. An additional robotic arm was placed on the right side of the patient's abdomen for the 4-arm robotic approach. The mean age, body mass index, cell type, Fédération Internationale de Gynécologie et d'Obstétrique stage, and type of surgery were not significantly different between the 2 cohorts. The 3-arm approach showed favorable outcomes over the 4-arm approach in terms of postoperative pain at 6 and 24 hours (3.8 ± 1.8 vs 4.5 ± 1.7 and 2.8 ± 1.7 vs 3.4 ± 1.6, respectively; p = .033 and .049) and postoperative hemoglobin difference (1.8 ± 0.9 vs 2.6 ± 1.3 and 1.9 ± 1.1 vs 2.4 ± 0.9 on days 1 and 3, respectively; p = .002 and .004). The median length of postoperative hospital stay, total operative time, docking time, lymph node yield, and intraoperative and postoperative complication rates were comparable between the 2 cohorts. ConclusionSurgical outcomes and complications rates of RRH for cervical cancer using the 4-arm approach were comparable with that of the 3-arm approach with decreased early postoperative pain in the 3-arm group. Cost-benefit analysis and the impact on surgical training are needed in the future.

Is intraarticular administration of tranexamic acid efficient and safe as systemic administration in total knee arthroplasty? Single center, randomized, controlled trial

This study aims to compare the efficiency and safety of intraarticular and intravenous tranexamic acid administration in patients who were performed primary total knee arthroplasty. This single center, randomized, controlled trial included 60 patients (8 males, 52 females; mean age 67.8 years; range 53 to 87 years) who were performed primary total knee arthroplasty by three surgeons due to a diagnosis of primary osteoarthritis between January 2015 and June 2015. Patients were separated into three groups. Patients in group 1 and group 2 were administered 2 g intravenous tranexamic acid and 2 g intraarticular tranexamic acid, respectively. Patients in group 3 were not administered tranexamic acid. Pre- and postoperative hemoglobin difference, volume of blood collected in drains, and transfusion rate were analyzed. Compared with the control group, there was no significant difference between group 1 and group 2 in terms of total blood loss from the drain, pre- and postoperative hemoglobin difference, and the need for blood transfusion. Both intraarticular and intravenous administrations reduce blood loss and need for transfusion and there is no significant difference between the two techniques in terms of safety.

Association of Epsilon-Aminocaproic Acid With Blood Loss and Risk of Transfusion After Periacetabular Osteotomy: A Retrospective Cohort Study

BackgroundPeriacetabular osteotomy (PAO) reorients the acetabular cartilage through a complex series of pelvic osteotomies, which risks significant blood loss often necessitating blood transfusion. Therefore, it is important to identify effective strategies to manage blood loss and decrease morbidity after PAO. The purpose of this study was to determine the association of epsilon-aminocaproic acid (EACA), an antifibrinolytic agent, with blood loss from PAO. MethodsNinety-three patients out of 110 consecutive patients that underwent unilateral PAO for acetabular dysplasia met inclusion criteria. Fifty patients received EACA intraoperatively. Demographics, autologous blood predonation, anesthetic type, intraoperative estimated blood loss (EBL), cell-saver utilization, and transfusions were recorded. Total blood loss was calculated. Two-sample t-test and chi-square or Fisher's exact test were used as appropriate. The associations between EACA administration and calculated EBL, cell-saver utilization, intraoperative EBL, and maximum difference in postoperative hemoglobin were assessed via multiple regression, adjusting for confounders. Post hoc power analysis demonstrated sufficient power to detect a 250-mL difference in calculated EBL between groups. Alpha level was 0.05 for all tests. ResultsNo demographic differences existed between groups. Mean blood loss and allogeneic transfusion rates were not statistically significant between groups (P = .093 and .170, respectively). There were no differences in cell-saver utilization, intraoperative EBL, and/or postoperative hemoglobin. There was a higher rate of autologous blood utilization in the group not receiving EACA because of a clinical practice change. ConclusionsEACA administration was not associated with a statistically significant reduction in blood loss or allogeneic transfusion in patients undergoing PAO.

Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity: a randomized controlled study

To determine the effect of routine intraoperative cervical dilatation during elective cesarean section on maternal morbidity. Patients with even numbers in the operative elective cesarean section list were included in the study. Of these, every second patient underwent intraoperative cervical dilatation. All participants in the two groups had otherwise similar preoperative care, operative procedures and subsequent clinical care. Blood loss was estimated and maternal infection status was assessed postoperatively by any rise of temperature or wound infection. Of the 131 patients included in the study, 67 underwent cervical dilation and 64 served as controls. There was no significant difference in postoperative hemoglobin, incidence of fever, or wound infection between the two groups. Only two of the cervical dilation group and one control patient developed postoperative fever. A hemoglobin drop of more than 0.5 g/dL was noted in 27 and 26 patients in the cervical dilation and the no dilation groups, respectively (NS). None of the study patients had signs of wound infection. Intraoperative cervical dilatation during elective cesarean section did not reduce the risk of postoperative maternal fever, wound infection or change in hemoglobin concentration.

The Impact of Introducing an Autologous Intraoperative Transfusion Device to a Community Hospital

The purpose of this study was to determine the benefits and disadvantages of transfusing autologous blood during abdominal aortic aneurysm (AAA) surgery at a district general hospital with an intraoperative autologous transfusion device (Haemoccel ABT 350). In this retrospective study, 128 patients underwent abdominal aortic aneurysm repair between 1992 and 1999 by a single vascular surgeon. Ninety-three patients (60 autologous and 33 allogeneic) had elective AAA repair (group A) and 25 patients (4 autologous and 21 allogeneic) had emergency AAA repair (group B). Nine group A patients (7.6%) received their own salvaged blood and no other allogeneic blood. Although the mean estimated blood loss was higher in the autologous group of patients (NS), the intraoperative autologous transfusion device did not significantly reduce allogeneic blood usage in patients who had autologous transfusion in both elective and emergency groups. There was no difference in postoperative hemoglobin and hematocrit, ICU stay or hospital stay. In this study, red cell salvage was significantly more expensive than blood bank usage (p < 0.0001), yet it did not significantly reduce the needs of allogeneic blood. We concluded that the intraoperative autologous transfusion device is underused, not cost-effective and requires formulation of local guidelines.

Prophylactic efficacy of low-dose dihydroergotamine and heparin in postoperative deep venous thrombosis following intra-abdominal operations

Postoperative pulmonary embolism continues to be a problem in patient care, especially in high-risk patients. This study was designed to evaluate a combined pharmacologic approach to the prophylaxis of postoperative deep venous thrombosis (DVT) by mediating at least two and probably three of Virchow's predisposing factors. Patients 40 years of age and older undergoing operations greater than 45 minutes under general anesthesia were placed in one of five treatment groups and studied by a prospective randomized, double-blind protocol. Study drugs were the following: (1) 0.5 mg of dihydroergotamine plus 5000 IU of sodium heparin (DHE 5000), (2) 0.5 mg DHE plus 2500 IU heparin (DHE 2500), (3) 5000 IU of HEP (HEP 5000), (4) 0.5 mg of DHE (DHE 0.5), and (5) a placebo. Study medications were administered 2 hours preoperatively and continuously thereafter every 12 hours postoperatively subcutaneously in the anterior abdominal wall for 5 to 7 days or until a positive radiofibrinogen uptake test (RFUT). The RFUT was performed according to standardized technique and was used to establish the presence or absence of DVT. This report is an analysis of the major subgroup of patients undergoing intra-abdominal operations. Results showed a highly statistically significant prophylactic benefit from DHE 5000 compared with the placebo (p < 0.003) and all other treatment groups (p < 0.05). There was no significant benefit from DHE 2500, HEP 5000 (p > 0.13), and DHE 0.5 (p > 0.3). All patients who entered the study had two or more risk factors for postoperative DVT, and high-risk patients were distributed equally throughout all treatment groups. DHE 5000 maintained its prophylactic benefit in high-risk patients. Evaluation of operative blood loss, postoperative blood loss, hematomas (wound or injection site), hematuria, postoperative hemoglobin difference, and adverse reactions revealed no significant difference between the study medications and the placebo. It is proposed that DHE 5000 has a synergistic prophylactic effect by mediating all three limbs of Virchow's triad: hypercoagulability (heparin), stasis (DHE), and vein wall injury secondary to venodilatation (DHE). DHE 5000 is recommended for patients at high risk of developing postoperative DVT and pulmonary embolism; however, it should be avoided in patients with acute myocardial infarction, sepsis, and sustained hypotension.