Volume Of Postoperative Blood Loss Research Articles

Clinical outcomes of transforaminal lumbar interbody fusion using a modified posterior spinous process-splitting approach for lumbar degenerative or isthmic spondylolisthesis: a prospective cohort study.

In the conventional posterior approach to the lumbar spine for transforaminal lumbar interbody fusion (TLIF), the paravertebral muscles are stripped from the spinous process. The authors developed a novel surgical procedure in which TLIF was performed via a modified spinous process-splitting (SPS) approach that enabled the preservation of the attachment of the paravertebral muscles to the spinous process. The SPS TLIF group comprised 52 patients with lumbar degenerative or isthmic spondylolisthesis who underwent surgery using a modified SPS TLIF technique, whereas the control group comprised 54 patients who underwent conventional TLIF. Compared with the control group, the SPS TLIF group had a significantly shorter operation time, smaller intra- and postoperative blood loss volumes, and shorter hospital stay and time to ambulation (p < 0.05). The SPS TLIF group had a lower mean visual analog scale score for back pain than the control group on both postoperative day 3 and at 2 years postoperatively (p < 0.05). Follow-up MRI showed changes in the paravertebral muscles in 46 of 54 patients (85%) in the control group and 5 of 52 patients (10%) in the SPS TLIF group (p < 0.001). This novel technique may be a useful alternative to the conventional posterior approach for TLIF.

Is it possible to predict postoperative blood loss in surgery for idiopathic scoliosis?

Postoperative drain loss can exceed intraoperative blood loss and affect the severity of the patient's condition.Aim: The objective of the study was to find significant predictors of postoperative blood loss in surgery for idiopathic scoliosis. We analyzed the data of 140 patients with idiopathic scoliosis. One hundred three patients (group 1) un-derwent Smith-Petersen osteotomy as part of the multilevel pedicle screw fixation; 37 patients (group 2) required no spinal osteotomy. Correlation and regression analysis of the data was performed. There were significant differences between the groups in the number of fixed segments (p.

ОСОБЕННОСТИ ПРИМЕНЕНИЯ ТРАНЕКСАМОВОЙ КИСЛОТЫ У ПАЦИЕНТОВ ПРИ КАРДИОХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВАХ

Objective. To evaluate the efficacy of tranexamic acid (TA) in cardiac surgery patients undergoing the open-heart surgery under conditions of artificial blood circulation (ABC) by determining the volume of perioperative blood loss using the hemoglobin balance method. Methods. A pilot non-randomized prospective clinical trial was conducted. To determine the effectiveness of TA use, 2 groups of patients were formed: the 1&lt;sup&gt;st&lt;/sup&gt; group, without TA application (n=40), the 2&lt;sup&gt;nd&lt;/sup&gt; group - with TA application intraoperatively (n=40). In group 2, prior to sternotomy, intravenous bolus injection of TA (1000 mg (20 ml of 5% solution)) was performed and further titration of TA through a syringe dispenser was continued at a rate of 4 ml/hour (200 mg/hour) until the end of the operation.The volume of intraoperative blood-loss was assessed by the hemoglobin balance method. A special protocol was developed to control the volume of postoperative blood loss. Results. The volume of circulating blood (VCB) calculated by Nadler’s formula for the first group was 5433.2 (5008.5; 5768.2) ml, for the second - 5214.0 (4944.1; 5546.8) ml. In the first group of patients who did not receive TA during open- heart surgery, the volume of blood loss was 1460.6 (1196.8; 1725.8) ml or 26.9 % of the average circulating blood volume (CBV), and in the second group of patients who received TA intraoperatively - 1090.7 (882.3; 1468.6) ml or 20.9% of the CBV (p&lt;0,001). Conclusion. The application of TA in cardiac surgery patients during open-heart surgery with ABC according to the developed algorithm (1000 mg/bolus, titration during surgery-200 mg/h) for the purpose of blood saving the volume of blood-loss was reduced by 25.3% compared to the control group. What this paper adds Algorithm for the use of tranexamic acid to reduce perioperative blood loss in cardiac surgery using cardiopulmonary bypass (CPB) during open-heart surgery has been developed. This algorithm included intravenous tranexamic acid injection (1,000 mg.) followed by titration during the operation - 200 mg/h). The use of this algorithm in cardiac surgical procedures allows reducing the volume of blood loss by 25.3%.

Effectiveness of Tranexamic Acid in Reducing Postoperative Blood Loss in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting.

BackgroundOff-pump coronary artery bypass grafting (OP-CABG) is an accepted surgical option in treating ischemic heart disease and has proven safer than traditional on-pump CABG in terms of reducing perioperative bleeding, coagulopathy, avoiding cardiopulmonary bypass machine and its related morbidity. However, there is evidence that shows the risk of bleeding in OP-CABG due to surgical trauma, heart manipulations, and heparin-protamine exposure. We aim to evaluate the effectiveness of tranexamic acid (TxA) in reducing blood loss and related perioperative complications in patients undergoing OP-CABG.MethodAn individual matched cohort study was conducted at a cardiac centre over a period of one year. We enrolled a total of 60 patients undergoing OPCABG in our study. The basic strategy was to enroll every possible intervention patient until the desired sample size (30 in each group) was achieved and then to select and enroll controls, using a prospective individual matching strategy. Preoperative cardiac risk evaluation was done using the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) in both groups. The intervention group (I) received TxA 10 mg/kg over 10 minutes at the time of induction while the control group (C) did not receive any TxA. Postoperative blood loss was measured by observing chest drain output 24 hourly till the chest drain tube was removed. Perioperative complications were also recorded.ResultsDemographics and baseline characteristics were comparable among groups (p > 0.05). The mean volume of postoperative blood loss in the I group at 24 hours and 48 hours were 352.67 ml and 86.83 ml, respectively. On the other hand, in the C group, the mean volume of postoperative blood loss was 602.00 ml and 166.3 ml. The data showed a statistically significant difference in the postoperative chest drainage output between the groups (unpaired t-test, p < 0.05) and exhibiting a significant reduction in postoperative blood loss in the I group. However, there was no significant difference in blood transfusion requirements in both of the groups (Mann Whitney U test, p > 0.05). The mean duration of postoperative complications, inotropic support, intermittent positive pressure ventilation, intensive care, and hospital stay were also comparable depicting no significant effect of TxA on reducing the perioperative morbidity.ConclusionThis study showed the significance of TxA in reducing bleeding in the postoperative period in patients undergoing OP-CABG.

Comparison of Modified Marmot Surgery and Lumbar Spinous Process Splitting Laminectomy in Lumbar Spinal Stenosis: Two-Year Outcomes.

Introduction Compared with the conventional posterior lumbar decompression surgery, the spinous process splitting approach for lumbar spinal stenosis is less invasive. There are currently two types of the spinous process splitting approach that are performed. First is the lumbar spinous process splitting laminectomy (LSPSL), which involves the detachment of the spinous process from the lamina. Second is the modified Marmot method, which involves leaning of the spinous process without detachment from the lamina. To the best of our knowledge, this is the first study comparing the 2-year surgical outcomes of the modified Marmot method and LSPSL in cases of lumbar spinal canal stenosis. Methods We recruited 69 patients who underwent decompression surgery. A total of 32 patients underwent the modified Marmot method (M group), and 37 patients underwent LSPSL (S group). We compared the clinical results, laboratory data of surgical invasion, wound pain, and safety. Results No significant difference was observed in terms of the demographic data and operative time between the two groups. The number of decompressed segments and intraoperative and postoperative blood loss volume in the M group were greater than that in the S group. In the S group, the postoperative Japanese Orthopedic Association scores and recovery rates were significantly greater compared with those in the M group. Perioperative complications did not significantly differ between the two groups. On postoperative day 1, the Postoperative Visual Analog Scale scores at rest in the M group were lower than those in the S group. Conclusions In clinical practice, we believe that posterior lumbar decompression surgery is safe, effective, and minimally invasive. Although the modified Marmot method may be less invasive and result in the reduction of wound pain during early postoperative periods, the clinical results did not exhibit greater long-term improvements with regard to surgical complications and neurological improvement, when compared with LSPSL.

Carotid Body Tumor Resection: Long-Term Outcome of 67 Cases without Preoperative Embolization

Carotid body tumors (CBTs) are rare tumors in the neck. Surgical resection is the gold standard of treatment. Surgical resection may be complicated by bleeding. Preoperative embolization has recently been introduced for the treatment to reduce the quantity of blood loss; however, the outcomes of this procedure are still under debate. In this article, we have presented the outcomes of patients who underwent surgical resection for CBT without undergoing preoperative embolization in our institution. This retrospective study reviewed 67 tumor resection cases who underwent surgical resection for CBTs without undergoing preoperative embolization. Tumor classification was performed as per the Shamblin classification. The demographic, clinical characteristics, and the operative information about the patients were retrieved from the patient records. The obtained data were analyzed with descriptive statistics. The study included 12 male and 55 female patients. The mean age was 51.95±16.59years. Of the surgically resected tumors; 11 (16.4%) were Shamblin type I, 30 (44.8%) were Shamblin type II, and 26 (38.8%) were Shamblin type III. The mean duration of operation was 109.10±32.36min. The volume of intraoperative blood loss in the Shamblin type I, type II, and type III groups were 98.64±23.46cc, 215.33±75.74cc, and 351.73±62.51cc, respectively, and they were significantly different among the groups (P<0.001). The volume of postoperative blood loss in the Shamblin type I, type II, and type III groups were 34.09±10.44cc, 53.00±20.02cc, and 62.50±25.11cc, respectively, and they were significantly different among the groups (P=0.003). Cranial nerve injury developed in 10 (15.0%) patients. Postoperative stroke developed in 2 (3%) patients. No mortality or persistent nerve injury was observed in association with the injury in the patients during the 1-year follow-up period. CBTs can be surgically resected safely and effectively without a need for preoperative embolization.

Indwelling Intrauterine Foley Balloon Catheter for Intraoperative and Postoperative Bleeding in Cesarean Scar Pregnancy

Study ObjectiveCesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, and a significant concern in the management of this condition is the control and prevention of bleeding. We aimed to determine the efficacy and value of an indwelling, intrauterine Foley balloon catheter in controlling and preventing intraoperative and postoperative bleeding in patients with CSP. DesignRetrospective case series. SettingUniversity-affiliated hospital. PatientsBetween January 1, 2015 and May 31, 2017, 70 patients presented with CSP. InterventionsAll patients underwent uterine curettage under hysteroscopic guidance and ultrasound monitoring. Patients were then assigned to 2 groups: the study group, with an indwelling Foley balloon catheter placed in the uterine cavity during surgery and retained for 24 to 48 hours, and the control group, without catheter placement. Data were collected to compare the 2 groups in terms of intraoperative and postoperative complications, surgical time, and status of menstruation resumption. Measurements and Main ResultsThe average daily volume of postoperative blood loss during the first 3 postoperative days in the study group was 23.1 mL compared with 31.5 mL observed in the control group (p = .041). Moreover, the study group had significantly shorter average duration of bleeding (p = .027) and fewer menstruation abnormalities than the control group. Uterine ultrasonography performed after resumption of menstruation showed that none of the enrolled patients had any intrauterine abnormalities. ConclusionsThe use of an indwelling, intrauterine Foley balloon catheter has positive results in the management of CSP.

Topical tranexamic acid in spinal surgery: A systematic review and meta-analysis

Tranexamic acid (TXA) is a commonly used antifibrinolytic agent for perioperative blood conservation in several surgical specialties. Although historically administered intravenously, such systemic administration may be accompanied by severe side effects. Thus, the topical usage of TXA has been established in several fields but remains poorly evaluated in spine surgery. In this study, the authors aimed to review the medical literature on topical TXA usage in spine surgery to evaluate its safety and efficacy. We reviewed manuscripts and clinical trials exploring topical TXA usage in spine surgery published by April 1st, 2018. Postoperative blood loss volumes and hospitalization lengths of stay were evaluated with separate meta-analyses. We identified five articles and one unpublished clinical trial that were placebo-controlled and comprised 218 patients receiving topical TXA in spine surgery. Patients receiving topical TXA demonstrated significantly lower postoperative blood loss as compared to the placebo group (Standardized Mean Difference [SMD] 2.21, 95% CI 0.79–3.62, p < 0.001) and had a lower hospitalization duration (MD 0.99, 95% CI 0.49–1.49, p < 0.001). Overall, topical TXA favorably reduced postoperative blood loss and hospitalization duration in patients undergoing spinal surgery. However, further randomized controlled trials will be needed to definitively establish the optimal therapeutic doses needed for hemorrhage management, and the pharmacodynamics of tTXA in spinal surgery.

The effect of initiating intravenous oxytocin infusion before uterine incision on the blood loss during elective cesarean section: a randomized clinical trial

Objective: This study compares the effect of starting intravenous oxytocin infusion early before uterine incision versus late after umbilical cord clamping on the blood loss during elective cesarean section (CS).Methods: A single-blinded randomized clinical trial conducted on 200 pregnant women at term (>37 weeks) gestation scheduled for elective CS were assigned to either IV infusion of 30 IU of oxytocin started before uterine incision (Group I) or started immediately after clamping the umbilical cord (Group II). The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean volume of postoperative blood loss, the mean reduction in the hemoglobin and hematocrit levels, the need for additional uterotonics, blood transfusion and additional surgical procedures.Results: The baseline characteristics of both groups are quiet similar. No statistical significant difference between both groups as regard to pre- and postpartum hemoglobin levels (p = .06 and 0.24 respectively) and hematocrit values (p = .12 and .51 respectively). There was a significant reduction in the intraoperative blood loss in group I compared with group II (432.7 ± 90.6 versus 588.9 ± 96.3 mL respectively, p = .001). The need for additional uterotonics was more frequent in the group II (19 women) than in group I (seven women) with statistical significance (p = .002). No differences between both groups regarding the need for blood transfusion or additional surgical procedures.Conclusions: Initiating intravenous oxytocin infusion before uterine incision during elective CS could be associated with reduction in the intraoperative blood loss and the need for additional uterotonics.

Acetabular components with or without screws in total hip arthroplasty

AIMTo compare the operation time, blood loss, and early outcomes of acetabular components with and without the screw.METHODSThirty patients who underwent cementless acetabular component with or without screw and whose follow-up exceeded one year period in total hip arthroplasty were evaluated. A posterior approach was used in all surgical procedures by one experienced surgeon. Demographic data, operation time, intra- and postoperative blood loss volume, follow-up clinical score, cup migration, and osteolysis were recorded. The Kolmogorov-Smirnov test was performed for testing the normality of study data. Mann-Whitney U test was used to analyze the inter-group differences. A P-value of ≤ 0.05 was considered statistically significant.RESULTSAcetabular components were used in 16 (53.3%) patients with screw and 14 (46.7%) without screw. After one year of follow-up, an osteolytic lesion of 3 mm was found in only one patient in the screw group. No cup migration was encountered. Intra-group mean Harris hip score significantly increased, but there was no significant inter-group difference. While the mean operation time of the screw group was 121.8 min (range; 95-140), it was 102.7 min (range; 80-120) in the no-screw group, and this difference was statistically significant (P = 0.002). The mean intraoperative/postoperative, and total blood loss were 556.6 mL (range: 350-800)/423.3 mL (range: 250-600), and 983.3 mL (range: 600-1350), respectively in the screw group; and 527 mL (range: 400-700)/456 mL (range: 230-600), and 983 mL (range: 630-1250), respectively in the no-screw group. The blood loss difference between the two groups was not significant. In the screw group, the operation time was 19.1 min longer than the no-screw group, and this difference was statistically significant.CONCLUSIONAcetabular components with or without screw have similar results, but the use of screw increases the operation time significantly, while not changing the blood loss volume.

LOCAL APPLICATION OF TRANEXAMIC ACID IN KNEE REPLACEMENT

The purpose of the study – assessment of the efficacy of local application of tranexamic acid in TKA and the choice of the optimal dosage. Materials and methods. 48 patients were included in open-prospective study and were randomized to one of four groups. In the first group tranexamic acid was used as intravenous bolus at the beginning of the operation at a dose of 15 mg/kg. Additionally, after the installation of the prosthetic components, the surgeon performed periarticular infiltration of soft tissue by tranexamic acid solution at a dose of 15 mg/kg. In the second group of patients tranexamic acid was used as 500 mg intravenous bolus before surgery, and 500 mg locally after installation of the prosthesis components. In the third group of patients received tranexamic acid once at the beginning of the operation at a dose of 15 mg/kg iv bolus. In the fourth group tranexam was used after surgery once at a dose of 10 mg/kg. Results. In the first group of patients were achieved statistically significant, 5-6 times, reduction of blood loss on drainage in comparison with other groups, where the volume of postoperative blood loss was not significantly different between groups. Also in the first group recorded the smallest decrease in hemoglobin at the 5th postoperative day compared to the third and fourth groups. Complications associated with the use of tranexamic acid were not revealed. Conclusion. The method of periarticular infiltration by tranexamic acid in combination with its intravenous use in knee joint replacement is an effective and safe method for reduction of post-operative blood loss.

Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis.

This meta-analysis was designed to compare the effectiveness and safety of intravenous (IV) versus topical administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty (TKA) by evaluating the need for allogenic blood transfusion, incidence of postoperative complications, volume of postoperative blood loss, and change in haemoglobin levels. Studies were included in this meta-analysis to check whether they assessed the allogenic blood transfusion rate, postoperative complications including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT), volume of postoperative blood loss via drainage, estimated blood loss, total blood loss, and change in haemoglobin levels before and after surgery in primary TKA with TXA administered through both the IV and topical routes. Ten studies were included in this meta-analysis. The proportion of patients requiring allogenic blood transfusion (OR 1.34, 95% CI 0.63-2.81; n.s.) and the proportion of patients who developed postoperative complications including PTE or DVT (OR 0.85, 95% CI 0.41 to 1.77; n.s.) did not significantly differ between the two groups. There was 52.3mL less blood loss via drainage (95% CI -50.74 to 185.66mL; n.s.), 52.1mL greater estimated blood loss (95% CI -155.27 to 51.03mL; n.s.), and 51.4mL greater total blood loss (95% CI -208.16 to 105.31mL; n.s.) in the topical TXA group as compared to the IV TXA group. The two groups were also similar in terms of the change in haemoglobin levels (0.02g/dL, 95% CI -0.36 to 0.39g/dL; n.s.). In primary TKA, there are no significant differences in the transfusion requirement, postoperative complications, blood loss, and change in haemoglobin levels between the IV and topical administration of TXA. In addition, results from subgroup analysis evaluating the effect of the times of TXA administration through the IV route suggested that double IV dose of TXA is more effective than single dose in terms of the transfusion requirements and blood loss via drainage. The current meta-analysis indicates that IV administration of 10mg/kg of TXA 20min before inflation of the tourniquet followed by 10mg/kg of TXA 15min before deflation of the tourniquet is effective and safe. The topical administration of 2g of TXA mixed with 100mL of normal saline after wound closure could be an alternative option in patients at greater risk of thromboembolic complications. Meta-analysis, Level III.

Preoperative thrombin generation is predictive for the risk of blood loss after cardiac surgery: a research article

BackgroundIn this study the value of thrombin generation parameters measured by the Calibrated Automated Thrombography for prediction of blood loss after cardiac surgery with cardiopulmonary bypass was investigated.MethodsThirty male patients undergoing first-time coronary artery bypass grafting were enrolled. Blood samples were taken pre-bypass before heparinisation (T1) and 5 min after protamine administration (T2). Thrombin generation was measured both in platelet-rich plasma and in platelet-poor plasma. Besides thrombin generation measurements, activated clotting time, haematocrit, haemoglobin, platelet number, fibrinogen, antithrombin, D-dimers, prothrombin time and activated partial thromboplastin time were determined. Blood loss was measured and the amount of transfusion products was recorded postoperatively until 20 hours after surgery. Patients were divided into two groups based on the median volume of postoperative blood loss (group 1: patients with median blood loss <930 ml; group 2: patients with median blood loss ≥930 ml).ResultsOn T1, patients of group 2 had a significantly lower endogenous thrombin potential and peak thrombin (p<0.001 and p=0.004 respectively) in platelet-rich plasma, a significantly lower endogenous thrombin potential (p=0.004) and peak thrombin (p=0.014) in platelet-poor plasma, and a lower platelet count (p=0.002). On T2 both endogenous thrombin potential and peak thrombin remain significantly lower (p=0.011 and p=0.010) in group 2, measured in platelet-rich plasma but not in platelet-poor plasma. In addition, platelet number remains lower in group 2 after protamine administration (p=0.002).Conclusions The key finding is that the Calibrated Automated Thrombography assay, performed preoperatively, provides information predictive for blood loss after cardiac surgery.

Local administration of tranexamic acid in off-pump coronary artery bypass

We administered tranexamic acid locally to patients undergoing off-pump coronary artery bypass, to investigate the hemostatic effects and safety. The subjects were 100 consecutive patients who underwent off-pump coronary artery bypass between July 2009 and January 2011. We assigned 50 patients in the early phase, in which tranexamic acid was not employed, to group N, and 50 in the late phase, in which tranexamic acid was employed, to group T. In group T, 10 mL of a solution containing 1 g of tranexamic acid in was sprayed into the pericardial cavity and mediastinum before the sternum was closed. We compared the volume of postoperative blood loss, blood transfusion volume, and complications between the 2 groups. The volume of blood loss in 24 h after intensive care unit admission was 492 mL in group N and 303 mL in group T (p<0.0001); the decrease in blood loss in the group receiving tranexamic acid was approximately 40%. There was no significant difference in the blood transfusion volumes. There were no side effects of tranexamic acid. In patients undergoing off-pump coronary artery bypass, local administration of tranexamic acid may decrease the volume of postoperative blood loss. The local administration method is simple, inexpensive, and safe.

Optimizing the technique of laparoscopic splenectomy in children

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Dzielicki J, Grabowski A, Korlacki W. Optimizing the technique of laparoscopic splenectomy in children. Videosurgery and Other Miniinvasive Techniques. 2010;5(1):19-26. doi:10.5114/wiitm.2010.13602. APA Dzielicki, J., Grabowski, A., & Korlacki, W. (2010). Optimizing the technique of laparoscopic splenectomy in children. Videosurgery and Other Miniinvasive Techniques, 5(1), 19-26. https://doi.org/10.5114/wiitm.2010.13602 Chicago Dzielicki, Józef, Andrzej Grabowski, and Wojciech Korlacki. 2010. "Optimizing the technique of laparoscopic splenectomy in children". Videosurgery and Other Miniinvasive Techniques 5 (1): 19-26. doi:10.5114/wiitm.2010.13602. Harvard Dzielicki, J., Grabowski, A., and Korlacki, W. (2010). Optimizing the technique of laparoscopic splenectomy in children. Videosurgery and Other Miniinvasive Techniques, 5(1), pp.19-26. https://doi.org/10.5114/wiitm.2010.13602 MLA Dzielicki, Józef et al. "Optimizing the technique of laparoscopic splenectomy in children." Videosurgery and Other Miniinvasive Techniques, vol. 5, no. 1, 2010, pp. 19-26. doi:10.5114/wiitm.2010.13602. Vancouver Dzielicki J, Grabowski A, Korlacki W. Optimizing the technique of laparoscopic splenectomy in children. Videosurgery and Other Miniinvasive Techniques. 2010;5(1):19-26. doi:10.5114/wiitm.2010.13602.

Using the Growth Factors-enriched Platelet Glue in Spinal Fusion and its Efficiency

Prospective study. To determine if the use of platelet glue enhances fusion in instrumented posterolateral lumbar fusion. Platelet gel is an osteoinductive material that has been used to enhance fusion rates in lumbar fusion surgery. There are questions, however, regarding the less adhesive property of platelet gel, and whether it is sufficient to ensure appropriate attachment of bone grafts. In the present study, we used fibrin gel with the adhesive property to reinforce the platelet gel structure and to deliver growth factors. We hypothesized that the platelet gel/fibrin glue composite (platelet glue) would increase fusion rates in posterolateral lumbar fusion. The control group consisted of 33 consecutive patients who received instrumented posterolateral lumbar fusion with artificial bone expander and laminectomy autograft. Thirty-four patients in the study group were treated as above with the additional platelet glue. There was no significant difference between 2 groups in the demography of patients. The amount of postoperative drainage on the first and second day was recorded. Fusion rates were also assessed. Diagnosis of union was based on flexion-extension dynamic lateral radiography and fine-cut computerized tomography. All patients have been monitored for at least 2 years. The nonunion rate in the platelet glue group was 15% as compared with 10% in the control group. The mean postoperative drainage on the first and second day was 362 mL in the control group and 395 mL in the platelet glue group. There were no significant differences in either fusion rate or postoperative blood loss volume between the 2 groups. In the present study, the use of a platelet gel/fibrin glue composite (platelet glue) could not be proved to increase fusion rates in instrumented lumbar posterolateral fusion. Further investigation is warranted to find an adequate carrier of growth factors for use in instrumented lumbar posterolateral fusion.

Sonoclot analysis in elderly compared with younger patients undergoing coronary surgery

The Sonoclot analyzer is a point-of-care method for assessment of the clotting mechanism in whole blood. The results are available within 20 min. The aim of the present study was to investigate whether repeated Sonoclot analyses could identify peri-operative differences in hemostatic function between elderly and younger patients undergoing coronary artery bypass grafting (CABG). In addition, we investigated whether Sonoclot analyses could identify disturbances in hemostatic function leading to post-operative bleeding. Twenty-five elderly and 25 younger patients undergoing CABG were included. Blood samples for Sonoclot analyses were drawn pre-operatively, during surgery, and during the first 20 post-operative hours. The Sonoclot variables sonACT, clot rate, time-to-peak, amplitude of the peak, and R3 were analyzed, and the results were compared between the two groups. Post-operative blood loss volumes were recorded and correlated to the Sonoclot variables. The Sonoclot variables were also correlated to previously reported results on various hemostatic variables measured in the same patient population. There was a significant difference in sonACT between the two groups (P=0.018). There were no differences between the groups in any of the other Sonoclot variables. There were no significant correlations between any of the Sonoclot variables and post-operative bleeding, or between the Sonoclot variables and other hemostatic variables. The difference in sonACT between the two groups indicates a reduced hemostatic function in the elderly patients. However, repeated Sonoclot analyses were not able to identify more specific disturbances in hemostatic function, and did not predict increased post-operative bleeding.

심장수술시 심폐기 충전액에 첨가된 저용량 aprotinin의 효과

Serine protease 억제약물인 aprotinin은 체외순환을 동반한 심장수술 후 필연적으로 발생하는 혈액성분 손상을 포함한 유해한 합병증을 감소시키기 위해 사용한다. 그러나 이 약물의 용량이나 사용법에 대해 여전히 논란의 여지가 있다. 본 연구자들은 심장수술 동안 심폐기 충전액에 저 용량의 aprotinin을 투여하여 그 효과를 연구하였다. 30명의 성인 심장수술 환자들을 대상으로 aprotinin 투여군(n=15)과 대조군(n=15)으로 나눈 뒤 수술 전, 동안, 후의 시기에 혈액학적 및 생화학적 변수들, 사이토카인 및 심장 표지자, 수술 후 각종 임상결과들을 비교분석 하였다. 혈소판수와 activated partial thromboplastin time은 수술 후 24시간 때 아프로티닌군이 대조군 보다 유의하게 높았다. Troponin-I 농도와 수술 후 출혈량은 아프로티닌군이 대조군보다 유의하게 낮았다. 이러한 결과들을 볼 때 심장수술시 저 용량의 aprotinin을 심폐기 충전액에 첨가하는 방법은 혈소판의 파괴를 줄여줘 수술 후 출혈량의 감소를 제공해주며 심근보호 효과가 있는 것으로 판단된다. 향후 더 많은 성인 환자군과 소아환자에 대한 다양한 연구가 더 많이 수행되어야 할 것으로 사료된다. Aprotinin, a serine protease inhibitor, has been used to ameliorate the inevitable consequences, including blood component injury after cardiac surgery with cardiopulmonary bypass (CPB). However, there are many arguments on its dosage or usage. We assessed whether administration of low dose of aprotinin in only priming solution has any beneficial effect or reduces its side effects on cardiac surgery. Thirty patients scheduled for elective cardiac surgery were randomly assigned to aprotinin group (n=15) which received aprotinin in priming solution (two million kallikrein inhibitory unit, KIU) and added one million KIU at 1 hour after the beginning of CPB or control group (n=15) which did not receive it. Hematological and biochemical variables, cytokines and cardiac marker levels, and postoperative outcomes were compared between two groups at before, during or after operation. Platelet count in aprotinin group was higher than that of control group at postoperative 24 hr. Activated partial thromboplastin time in aprotinin group was longer than that of control group at intensive care unit (ICU). Troponin-I level and postoperative blood loss volumes in aprotinin group were lower than those of control group at ICU. There were no significant differences between the two groups on the others. These results showed that low dosage of only priming solution during cardiac surgery with CPB reduced platelet destruction and postoperative bleeding, and attenuates myocardial damage. However, further studies need to be carried out with more population or pediatric patients for evaluating various aprotinin usage.

Effectiveness of Autologous Fibrin Tissue Adhesive in Reducing Postoperative Blood Loss during Total Hip Arthroplasty: A Prospective Randomised Study of 100 Cases

To evaluate the effectiveness of autologous fibrin tissue adhesive (auto-FTA) in reducing blood loss during cementless total hip arthroplasty (THA). From September 2000 to August 2001, 100 patients who predonated 400 ml of autologous blood were randomised to undergo either standard treatment with auto-FTA (auto-FTA group) or standard treatment alone (control group). The volume of postoperative blood loss and the decrease in haemoglobin level were measured. All patients were followed up for 3 years to evaluate the rate of bone ingrowth and heterotopic ossification. The mean postoperative blood loss was 580 ml (standard deviation [SD], 240 ml) in the auto-FTA group and 810 ml (SD, 341 ml) in the control group; the difference was significant (230 ml, p<0.001). The decrease in haemoglobin concentration was 17 g/l (SD, 11 g/l) in the auto-FTA group and 22 g/l (SD, 12 g/l) in the control group. The difference was significant (5 g/l, p=0.03). The percentage of total blood loss of >1200 ml in any single patient was significantly lower in the auto-FTA group (4%) than in the control group (20%) [p=0.01]. Auto-FTA is a safe and effective means of reducing perioperative blood loss in THA.

Effect of INS50589, a Reversible ADP-Receptor Antagonist, on Platelet Function and Blood Loss in a Canine Model of Cardiopulmonary Bypass.

Open-heart surgery performed with cardiopulmonary extracorporeal bypass (CPB) of anticoagulated blood often is complicated by excessive postoperative hemorrhage due to an acquired platelet function defect and thrombocytopenia inherent to the procedure. One strategy for reducing excessive blood loss is to protect the platelets pharmacologically from activation and damage during the surgical procedure and the CPB, but most inhibitors of platelet activation used in this way would exacerbate bleeding because of the duration of their effect. INS50589 is a competitive and selective P2Y12 receptor antagonist in development by Inspire Pharmaceuticals Inc. Previous studies in normal dogs indicate that 20μM ADP induced ex vivo whole blood platelet aggregation is completely inhibited by the administration of INS50589 and that the effect is quickly reversed upon discontinuation of the administration. This drug is now being tested for efficacy and safety in a canine model of CPB established at East Carolina University. Subjects in the range of 20–30 kg are prepared by sternotomy for extracorporeal recirculation of blood after systemic heparinization. CPB occurs for ninety minutes, followed by weaning from the pump and maintenance for a four hour postoperative period. INS50589 was administered by continuous infusion at a rate of 17 mg/kg/min at initiation of sternotomy and throughout CPB until weaned. Special testing in all subjects includes ex vivo whole blood aggregometry with two doses of ADP, thromboelastography with the TEG® ADP Mapping kit, bleeding times using a 23 gauge puncture of the exposed jugular vein, and measurements of blood loss from the surgical fields. In the placebo treated group, there was a significant loss of platelet response to ADP during CPB that remained in the post-op period at approx 50% of initial values; in contrast, the drug-treated subjects show post-op recovery of ADP response to within 90% of initial values (p<0.01). The vessel bleeding time (VBT) within both groups was greatly prolonged during CPB. Preliminary analysis suggests that in the post-operative period the VBT returned to baseline values after the infusion was discontinued; however, the return was faster in the INS50589 -treated animals when compared with the placebo group. The volume of post-operative blood loss was variable but appears to be less in the drug-treatment group versus placebo controls. When adjusted on the basis of red cell mass in the shed blood per body weight the difference was significant (4.78±1.99e10 vs. 10.1±2.91e10 red blood cells/kg), p <0.05. Other preliminary findings in the treatment group included a lesser CPB-related decrease in platelet count, a higher average hematocrit, higher post-op fibrinogen concentration, and a more stable post-op course. These preliminary findings suggest that INS50589 should be effective in protecting platelet function and reducing blood loss in human patients undergoing open-heart surgery.