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Article in Chinese | WPRIM | ID: wpr-879382


OBJECTIVE@#To evaluate the clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement.@*METHODS@#Totally 34 patients (34 hips) with femoroacetabular impingement underwent hip arthroscopy from June 2016 to December 2018, were randomly divided into two groups named as tranexamic acid group and control group, 17 patients in each group. In TXA group, there were 10 males and 7 females, aged from 20 to 49 years old with an average of (32.1±7.6) years old;15 mg/kg TXA was intravenous drops before operation incision performed at 10 min. In control group, there were 11 males and 6 females, aged from 20 to 49 years old with an average of (30.9±6.2) years old;100 ml normal saline was intravenous drops before operation incision performed at 10 min. Introopertaive and total bloodloss between two groups were compared. Visual analogue scale (VAS) at 3 and 7 days after opertaion were used to evaluate pain relief of hip joint. Modified Harris Hip Score(mHHS) of hip joint at 3, 6, 9 and 12 weeks after oeprtaion were applied to evaluate clinical effects.@*RESULTS@#All patients were obtained follow up over 12 weeks. Incision healed well without infection and deep vein thrombosis. There were no statistical difference in opertaion time bewteen two groups(@*CONCLUSION@#Preoperative application of tranexamic acid could effectively reduce blood loss in arthroscopy for femoroacetabular impingement, thereby improving surgical field of vision, reducing difficulty of surgical operation, which could promote early and rapid rehabilitation of hip function.

Adult , Aged , Arthroscopes , Arthroscopy , Blood Loss, Surgical , Female , Femoracetabular Impingement/surgery , Hip Joint/surgery , Humans , Male , Middle Aged , Tranexamic Acid , Treatment Outcome , Young Adult
Article in English | WPRIM | ID: wpr-878333


Objective@#This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss (IBL) in placenta accreta spectrum (PAS) disorders.@*Methods@#A retrospective cohort study was conducted between January 2015 and November 2019. Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 mL among groups with different ultrasonic scores.@*Results@#A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores (low score group: ≤ 6 points, @*Conclusions@#The risk of blood loss equal to or greater than 1,500 mL increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.

Adult , Blood Loss, Surgical/statistics & numerical data , Female , Gestational Age , Humans , Logistic Models , Placenta Accreta/surgery , Predictive Value of Tests , Pregnancy , Retrospective Studies , Risk , Ultrasonography, Prenatal/statistics & numerical data
Rev. bras. ortop ; 55(2): 181-184, Mar.-Apr. 2020. tab
Article in English | LILACS | ID: biblio-1138011


Abstract Objective The aim of the present study is to identify the incidence, predisposing factors and prognostic impact of blood loss in patients with neuromuscular scoliosis submitted to corrective surgery. Methods Retrospective cohort study, including pediatric patients diagnosed with neuromuscular scoliosis undergoing instrumentation and posterior vertebral fusion in a university hospital. Patient characteristics were collected from the hospital information system. Results A total of 39 patients were included in the study. The intraoperative blood losses were 962 ml, representing a loss of 35.63% of the blood volume. In 20 cases, there was a massive blood loss (> 30%) and only 7 patients did not need a transfusion. The group of patients with massive blood loss had a slightly higher age (13.75 versus 13.53 years old), a lower body mass index (BMI) percentile (25 versus 50), and for each decrease of 0.38 in the BMI, intraoperative blood losses increased 1% (p < 0.05). The value of preoperative albumin had influence on the percentage of blood loss, and for each decrease of 0.4 of albumin, blood loss increased 1% (p < 0.05). Conclusions The factors that most contributed to the differences in blood loss were age, BMI, and preoperative albumin value. There was no significant association between Cobb angle, number of fusion levels and duration of surgery. We can conclude that these patients would benefit from preoperative nutritional control.

Resumo Objetivo O objetivo do presente estudo é identificar a incidência, os fatores predisponentes e o impacto prognóstico da perda de sangue em pacientes com escoliose neuromuscular submetidos a cirurgia corretiva. Métodos Estudo de coorte retrospectiva, incluindo pacientes pediátricos com diagnóstico de escoliose neuromuscular submetidos a instrumentação e fusão vertebral posterior em um hospital universitário. As características dos pacientes foram coletadas no sistema de informações do hospital. Resultados Um total de 39 pacientes foram incluídos no estudo. As perdas sanguíneas intraoperatórias foram de 962 mL, representando uma perda de 35,63% do volume sanguíneo; a perda de sangue foi extensa em 20 casos (> 30%) e apenas 7 pacientes não necessitaram de transfusão. O grupo de pacientes com perda maciça de sangue apresentou idade um pouco maior (13,75 versus 13,53 anos) e menor percentil do índice de massa corporal (IMC) (25 versus 50); para cada diminuição de 0,38 no IMC, as perdas sanguíneas intraoperatórias aumentaram 1% (p < 0,05). A concentração pré-operatória de albumina influenciou o percentual de perda de sangue e, para cada diminuição de 0,4 de albumina, a perda de sangue aumentou 1% (p < 0,05). Conclusões Os fatores que mais contribuíram para as diferenças na perda sanguínea foram idade, IMC e concentração pré-operatória de albumina. Não houve associação significativa entre ângulo de Cobb, número de níveis de fusão e duração da cirurgia. Podemos concluir que esses pacientes se beneficiariam do controle nutricional pré-operatório.

Humans , Scoliosis , Blood Volume , Blood Loss, Surgical , Neuromuscular Diseases
Rev. otorrinolaringol. cir. cabeza cuello ; 80(1): 63-68, mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1099203


Las cirugías de cabeza y cuello presentan un alto riesgo de sangrado que puede significar el uso de transfusiones sanguíneas. Existen casos en las que éstas son rechazadas, como sucede con los Testigos de Jehová. Se expone el caso de una paciente Testigo de Jehová con un tumor rinosinusal con alto riesgo de sangrado que consultó por epistaxis recurrente. Se evidencia un tumor ocluyendo la fosa nasal derecha de aspecto vascular a la rinoscopía y la tomografía computarizada. Múltiples aferencias de la arteria esfenopalatina y etmoidales se observaron en una angiografía cerebral. Previo a la resección, se embolizó la arteria maxilar. Durante la cirugía, se contó con un sistema de recuperación de sangre autóloga, hemodilución e infusión de ácido tranexámico. Se ligó la arteria etmoidal anterior derecha vía externa con apoyo endoscópico y luego se resecó el tumor vía endoscópica. La biopsia reveló un carcinoma sinonasal escamoso. Existen alternativas terapéuticas en pacientes que rechacen el uso de hemoderivados. Destacan medidas preoperatorias como la embolización endovascular, intraoperatorias como el uso de agentes hemostáticos, técnicas quirúrgicas y anestésicas. Es importante analizar todas las opciones disponibles de forma multidisciplinara y junto con el paciente, para determinar la conducta más adecuada a seguir.

Head and neck surgeries have a high risk of bleeding, and therefore could require the use of blood transfusions. There are cases for which blood transfusions are not an acceptable option, as is the case for Jehovah's Witnesses. We present the case of a Jehovah's Witness with a sinonasal tumor with a high risk of bleeding, who presented with recurrent epistaxis. Rhinoscopy and computed tomography revealed a vascular-like tumor occluding the right nasal cavity. Cerebral angiography showed afferents of the sphenopalatine and ethmoidal arteries leading to the tumor. Prior to the resection, the maxillary artery was embolized. During surgery, we relied on an autologous blood recovery system, hemodilution and tranexamic acid. Right anterior ethmoidal artery ligation was performed by an endoscopic assisted external approach. The tumor was resected endoscopically The biopsy revealed a squamous sinonasal carcinoma. There are therapeutic alternatives for patients who cannot receive blood products. There are preoperative measures such as endovascular embolization, intraoperative measures such as the use of hemostatic agents and specific surgical or anesthetic techniques. It's important to analyze all of the available options in a multidisciplinary team approach, and to take into consideration the patient's preferences, in order to determine the best surgical conduct.

Humans , Female , Middle Aged , Carcinoma, Squamous Cell/surgery , Nose Neoplasms/surgery , Jehovah's Witnesses , Religion and Medicine , Paranasal Sinus Neoplasms/surgery , Carcinoma, Squamous Cell/diagnostic imaging , Tomography, X-Ray Computed , Nose Neoplasms/diagnostic imaging , Blood Loss, Surgical/prevention & control , Treatment Refusal , Embolization, Therapeutic , Hemodilution
Braz. j. otorhinolaryngol. (Impr.) ; 86(1): 111-118, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089362


Abstract Introduction Tranexamic acid is a hemostatic agent, which inhibits fibrin degradation, which may be beneficial in controlling bleeding during surgery. Objectives The purpose of this study was to provide a meta-analysis and review of the effects of tranexamic acid on hemorrhage and surgical fields and side effects on patients during endoscopic sinus surgery. Methods Two authors independently searched six databases (Medline, Scopus, Embase, Web of Science, Google Scholar and Cochrane library) from the start of article collection until July 2018. Postoperative complications such as intraoperative bleeding, operative time, hypotension, nausea, vomiting, and coagulation profile were included in the analysis of tranexamic acid (Treatment Group) and placebo (Control Group) during the operation. Results The amount of blood loss during surgery was statistically lower in the treatment group compared to the placebo group, and the surgical field quality was statistically higher in the treatment group than in the placebo group. On the other hand, there was no significant difference in operation time, hemodynamics, or coagulation profile between groups. In addition, tranexamic acid had no significant effect on vomiting and thrombosis compared to the Control Group. Conclusion This meta-analysis has shown that topical administration of tranexamic acid can reduce the amount of bleeding during surgery and improve the overall quality of the surgery. Hemodynamic instability during surgery, vomiting after surgery, or abnormal clotting profile were not reported. Additional studies are needed to confirm the results of this study because there are fewer studies.

Resumo Introdução O ácido tranexâmico é um agente hemostático, que inibe a degradação da fibrina e pode ser benéfico no controle do sangramento durante a cirurgia. Objetivos Fazer uma metanálise e revisão dos efeitos do ácido tranexâmico na hemorragia e nos campos cirúrgicos e efeitos colaterais em pacientes durante a cirurgia endoscópica do seio nasal. Método Dois autores realizaram independentemente uma busca em seis bancos de dados (Medline, Scopus, Embase, Web of Science, Google Scholar e Cochrane) desde o início da coleta de artigos até julho de 2018. Complicações pós-operatórias como sangramento intraoperatório, tempo operatório, hipotensão, náusea, vômitos e perfil de coagulação foram incluídos na análise do ácido tranexâmico (grupo de tratamento) e placebo (grupo controle) durante a cirurgia. Resultados A quantidade de perda de sangue durante a cirurgia foi estatisticamente menor no grupo de tratamento comparado com o grupo placebo e a qualidade do campo cirúrgico foi estatisticamente maior no grupo de tratamento do que no grupo placebo. Por outro lado, não houve diferença significante no tempo cirúrgico, hemodinâmica ou perfil de coagulação entre os grupos. Além disso, o ácido tranexâmico não teve efeito significante na ocorrência de vômitos e trombose em comparação ao grupo controle. Conclusão Esta metanálise mostrou que a administração tópica de ácido tranexâmico pode reduzir a quantidade de sangramento durante a cirurgia e melhorar a qualidade geral dela. Instabilidade hemodinâmica durante a cirurgia, vômitos após a cirurgia ou perfil de coagulação anormal não foram relatados. Estudos adicionais são necessários para confirmar os resultados desta pesquisa, porque há poucos estudos na literatura.

Humans , Tranexamic Acid/pharmacology , Epistaxis/drug therapy , Blood Loss, Surgical/prevention & control , Intraoperative Complications/drug therapy , Antifibrinolytic Agents/pharmacology , Tranexamic Acid/administration & dosage , Randomized Controlled Trials as Topic , Administration, Topical , Endoscopy/adverse effects , Nasal Surgical Procedures/adverse effects , Intraoperative Complications/etiology , Anesthesia, General , Antifibrinolytic Agents/administration & dosage
Article in Chinese | WPRIM | ID: wpr-879354


OBJECTIVE@#To investigate the effect of intra-articular injection of tranexamic acid on blood loss and blood transfusion rate after minimally invasive unicompartmental knee arthroplasty.@*METHODS@#From January 2015 to September 2017, 90 patients underwent minimally invasive unicompartmental knee arthroplasty were divided into tranexamic acid group and control group, 45 cases in each group. In the tranexamic acid group, there were 22 males and 23 females, aged 62 to 69 (66.1±2.4) years;in the control group, 20 males and 25 females, aged 63 to 71(68.5±5.2) years. The amount of bleeding in the drainage ball at 48 hours after operation was recorded, and the blood transfusion rate and hematocrit level duringthe perioperative period were recorded. The factors influencing perioperative blood loss included gender, age and body mass index (BMI).@*RESULTS@#All patients were followed up for 12.5 to 28.3 (22.8±7.9) months. During the follow-up, the wounds of the two groups healed well, and no deep vein thrombosis and pulmonary embolism occurred. There was no significant difference in postoperative blood loss between the tranexamic acid group and the control group. The postoperative bleeding volume in the tranexamic acid group was (110.0±52.1) ml, and that in the control group was (123.0±64.5) ml (P=0.39). There was no blood transfusion in the two groups.@*CONCLUSION@#Intra articular injection of tranexamic acid can not significantly reduce the postoperative blood loss in patients with minimally invasive unicompartment.

Aged , Antifibrinolytic Agents/therapeutic use , Arthroplasty, Replacement, Knee/adverse effects , Blood Loss, Surgical/prevention & control , Female , Hemostatics , Humans , Injections, Intra-Articular , Male , Middle Aged , Postoperative Hemorrhage , Tranexamic Acid
Article in Chinese | WPRIM | ID: wpr-879348


OBJECTIVE@#To evaluate the efficacy and safety of local application of tranexamic acid (TXA) in reducing perioperative blood loss in total hip arthroplasty via direct anterior approach (DAA).@*METHODS@#From July 2013 to September 2018, 46 patients with avascular necrosis of the femoral head were divided into tranexamic acid group (@*RESULTS@#The incision healed well and no obvious complications occurred in the two groups. All patients were followed up for 12 to 59 months(averaged 31.11 months). No hip pain was found in the follow-up patients. Hip joint function was improved effectively and no prosthesis loosening occurred. The total perioperative blood loss in tranexamic acid group and normal saline group was(740.09±77.14) ml and (1 069.07±113.53) ml respectively, 24 hours after operation, the drainage volume was (87.61±9.28) ml, (233.83±25.62) ml, the hidden blood loss was (409.65±38.01) ml and (588.33±57.16) ml. the difference of hemoglobin before and after operation was (24.78±2.19) g / L and (33.57±2.95) g / L, the difference was statistically significant (@*CONCLUSION@#local application of tranexamic acid in total hip arthroplasty through direct anterior approach can safely and effectively reduce perioperative blood loss, and does not increase the risk of thrombosis, and does not affect the normal recovery of joint function.

Aged , Antifibrinolytic Agents/therapeutic use , Antiviral Agents , Arthroplasty, Replacement, Hip/adverse effects , Blood Loss, Surgical/prevention & control , Female , Hepatitis C, Chronic , Humans , Male , Middle Aged , Safety , Tranexamic Acid/therapeutic use , Treatment Outcome
Chinese Medical Journal ; (24): 2816-2821, 2020.
Article in English | WPRIM | ID: wpr-877937


BACKGROUND@#The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.@*METHODS@#A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.@*RESULTS@#There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.@*CONCLUSIONS@#Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.

Blood Loss, Surgical , Cervical Vertebrae/surgery , Decompression, Surgical , Humans , Laminoplasty , Retrospective Studies , Spinal Cord Diseases/surgery , Spinal Fusion , Spondylosis/surgery , Treatment Outcome
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 403-407, Out.-Dez. 2019. tab
Article in English | LILACS | ID: biblio-1024212


Introduction: Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage. Objective: The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage. Methods: A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate. Results: A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases. Conclusion: The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage (AU)

Humans , Male , Female , Adolescent , Adult , Tonsillectomy/adverse effects , Postoperative Hemorrhage/etiology , Pulse , Retrospective Studies , Risk Factors , Blood Loss, Surgical , Postoperative Hemorrhage/therapy , Operative Time , Arterial Pressure , Hospitals, University , Intraoperative Period
Int. braz. j. urol ; 45(4): 747-753, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1019872


ABSTRACT Purpose This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. Materials and Methods A total of 272 patient's medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. Results 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the first 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. Conclusions During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.

Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Laparoscopy/adverse effects , Laparoscopy/methods , Adrenalectomy/adverse effects , Adrenalectomy/methods , Postoperative Period , Reference Values , Retrospective Studies , Risk Factors , Blood Loss, Surgical , Treatment Outcome , Adrenal Gland Neoplasms/surgery , Adrenal Gland Neoplasms/pathology , Adrenal Glands/surgery , Adrenal Glands/pathology , Statistics, Nonparametric , Risk Assessment , Tumor Burden , Perioperative Period , Operative Time , Length of Stay , Middle Aged
Rev. bras. ortop ; 54(3): 322-328, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013723


Abstract Objective The present study aimed to evaluate the results of the intraoperative topical use of a human fibrin sealant free of clot-stabilizing agents in total knee arthroplasties (TKAs), looking for differences between groups regarding blood loss, transfusion requirement, length of hospital stay, pain perception, range of motion (ROM), and incidence of complications. Methods We have analyzed prospectively an intervention group with 32 patients (Sealant) and a control group with 31 patients (Control) with symptomatic knee osteoarthritis who underwent TKA. Results The results were similar between the groups regarding visible blood loss in the drain in 24 hours (Control, 276.5 mL ± 46.24 versus Sealant, 365.9 mL ± 45.73), total blood loss in 24 hours (Control, 930 mL ± 78 versus Sealant, 890 mL ± 67) and in 60 hours after surgery (Control, 1,250 mL ± 120 versus Sealant, 1,190 mL ± 96), blood transfusion requirement (which occurred only in 1 control patient), length of hospital days stay (Control, 5.61 ± 0.50 versus Sealant, 4.81 ± 0.36), postoperative pain, and ROM. Sealant use was not related to wound healing complications, to infection, or to deep venous thrombosis. Conclusion We have concluded that the hemostatic agent composed of human fibrin was not effective in reducing bleeding volume and blood transfusion requirement, nor it interfered with hospital length of stay, pain perception, and ROM. Its use was not related to any complications.

Resumo Objetivo O objetivo do presente estudo foi avaliar os resultados do uso tópico intraoperatório do selante de fibrina humano livre de agentes estabilizadores de coágulo em pacientes com osteoartrite (OA) submetidos a artroplastia total de joelho (ATJ), buscando diferenças entre os grupos em relação à perda sanguínea, à necessidade transfusional, ao tempo de internação hospitalar, à percepção de dor, à amplitude de movimento e à incidência de complicações. Métodos Foram analisados prospectivamente um grupo de intervenção (Selante) com 32 pacientes e um grupo controle (Controle) com 31 pacientes, com OA sintomática dos joelhos, submetidos a ATJ. Resultados Os resultados foram semelhantes entre os grupos, em relação à perda sanguínea visível no dreno em 24 horas (Controle 276,5 mL ± 46,24 versus Selante 365,9mL ± 45,73), à perda sanguínea total em24 horas (Controle 930 mL ± 78 versus Selante 890 mL ± 67) e em 60 horas de pós-operatório (Controle 1.250 mL ± 120 versus Selante 1.190 mL ± 96), à necessidade de hemotransfusão (ocorreu em apenas 1 controle), ao tempo de dias na permanência hospitalar (Controle 5,61 ± 0,50 [n = 31] versus Selante 4,81 ± 0,36), dor pós-operatória e amplitude de movimento. O uso do agente selante de fibrina não se relacionou à ocorrência de complicações da cicatrização de ferida, de infecção ou de trombose venosa profunda. Conclusão Concluímos que o agente hemostático de fibrina humana não foi eficaz em reduzir o volume de sangramento e a necessidade de hemotransfusão ou em interferir no tempo de internação hospitalar, na percepção de dor e na amplitude de movimento. Seu uso não se relacionou a nenhuma complicação.

Humans , Male , Female , Middle Aged , Aged , Osteoarthritis , Arthroplasty , Fibrin Tissue Adhesive , Blood Loss, Surgical , Arthroplasty, Replacement, Knee
Article in Chinese | WPRIM | ID: wpr-773839


OBJECTIVE@#To explore clinical efficacy and safety of application of tranexamic acid for two times combined with postoperative hip and knee on flexion position for reducing blood loss during total knee arthroplasty.@*METHODS@#From January 2015 to January 2018, 90 patients with knee osteoarthritis underwent unilateral total knee arthroplasty, including 33 males and 57 females, aged from 61 to 85 years old with an average of(72.3±6.9) years old. The patients were randomly divided into three groups according to random number table, 30 patients in each group. In group A, there were 11 males and 9 females, aged from 61 to 84 years old with an average of (71.60±6.04) years old, body mass index was (26.04±1.95) kg/m², hemoglobin was(128.57±5.98) g/L, treated by 7.5 mg/kg tranexamic acid was injected intravenously before upper tourniquet, and 7.5 mg/kg tranexamic acid after closure of incision and before loosening tourniquet, meanwhile combined with flexion position of hip for 30° to 45° and flexion position of knee for 60° for 70°. In group B, there were 10 males and 20 females aged from 61 to 85 years old with an average of (72.04±7.47) years, body mass index was (25.92±1.70) kg/m², hemoglobin was (127.58±4.37) g/L, treated by 15 mg/kg tranexamic acid injected intravenously before loosening tourniquet. In group C, there were 12 males and 18 females aged from 62 to 85 years old with an average of (73.23±7.36) years, body mass index was (26.07±1.49) kg/m², hemoglobin was (128.31±5.61) g/L, treated with the same amount of normal saline before loosening tourniquet. Intraoperative bleeding volume, postoperative drainage volume, recessive blood loss, total blood loss volume, blood transfusion cases, activated partial thromboplastin time(APTT), prothrombin time(PT), prothrombin international standardized ratio (PT-INR) and indexes of D-dimer(D-D) were compared among three groups, as well as postoperative deep venous thrombosis and pulmonary embolism were observed among three groups.@*RESULTS@#No incision infection occurred in all 90 patients, and all patients were followed up from 4 to 8 months with an average of 6 months without pulmonary embolism occurred. There was no statistical difference in itraoperative bleeding volume among three groups(F=0.299, =0.742), while there were significant differences in postoperative drainage volume, recessive blood loss, and total blood loss among three groups. The number of blood transfusion were as following, 2 cases in group A, 8 cases in group B, and 16 cases in group C, there were statistically significant differences among three groups(χ² =16.01, 0.05), and no difference in occurrence of lower limb vein thrombosis after operation.@*CONCLUSIONS@#The method of using tranexamic acid before upper tourniquet, after closure of incision and before loosening tourniquet-combined with the flexion position of hip and knee could effectively reduce postoperative drainage volume, recessive bleeding, total blood loss and blood transfusion cases after total knee arthroplasty, while it does not increase risk of deep vein thrombosis and pulmonary embolism.

Aged , Aged, 80 and over , Antifibrinolytic Agents , Arthroplasty, Replacement, Knee , Blood Loss, Surgical , Female , Humans , Male , Middle Aged , Postoperative Hemorrhage , Therapeutics , Tranexamic Acid
Article in Chinese | WPRIM | ID: wpr-776139


OBJECTIVE@#To explore effect of early intermittently closing drainage tube on blood loss control after total knee arthroplasty.@*METHODS@#Totally 60 total knee replacement patients were randomly divided into experimental group and control group according to the different drainage ways of postoperative from January 2014 to January 2015. There were 30 patients in experimental group, including 12 males and 18 females, aged from 58 to 76 years old with an average of (67.0±6.7) years old, preoperative Hb was(128.82±8.29) g/L; drainage tubes were intermittently opened for 10 minutes every 2 hours, and kept opened until 6 h after operation. There were 30 patients in control group, including 13 males and 17 females; aged from 60 to 79 years old with an average of(69.0±7.2) years old; Preoperative Hb was(126.55±8.49) g/L; tubes were kept open with negative pressure before its removing. Blood loss in operation, postoperative drainage, total blood loss, hidden blood loss, allogenic blood transfusion and local wounds during hospitalization were observed and compared.@*RESULTS@#Postoperative drainage and total blood loss in experimental group was(184±56) ml, (1 014±258) ml; and significantly lower than that of control group(476±98)ml, (1 390±383) ml(0.05). The incisions between two groups were healed at stage I without infection. The size of limb swelling and the number of the cases with ecchymosis in experimental group was (3.8±0.9) cm and 10 respectively; control group was (3.4±0.7) cm and 8, while there were no significant differences between two groups(>0.05). Five patients in experimental group were performed blood transfusion, 13 patients in control group were performed blood transfusion, and with differences between two groups(<0.05).@*CONCLUSIONS@#Intermittently closing of drainage tube after 6 h of TKA could reduce the amount of drainage, total blood loss and blood transfusion rate, and not aggravate limb swelling and subcutaneous ecchymosed. It is proved to be an effective measure to reduce bleeding after TKA.

Aged , Antifibrinolytic Agents , Arthroplasty, Replacement, Knee , Blood Loss, Surgical , Blood Transfusion , Case-Control Studies , Drainage , Female , Humans , Male , Middle Aged , Postoperative Hemorrhage , Tranexamic Acid
ABCD arq. bras. cir. dig ; 32(3): e1454, 2019. tab, graf
Article in English | LILACS | ID: biblio-1038029


ABSTRACT Background: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. Aim: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. Methods : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. Results: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. Conclusion: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.

RESUMO Racional: A drenagem biliar percutânea é procedimento seguro. O risco de complicações hemorrágicas é aceitável. Frequentemente, os pacientes com obstruções biliares apresentam distúrbios de coagulação, aumentando o risco de sangramento. Por esse motivo, eles devem sempre ser adequados aos parâmetros da hemostasia. Objetivo: Determinar se a porcentagem de complicações hemorrágicas na drenagem biliar percutânea é maior em adultos com hemostasia corrigida antes do procedimento em relação àqueles que necessitaram nenhuma. Métodos: Estudo prospectivo, observacional, transversal, comparativo por amostras independentes (comparação não pareada). Oitenta e dois pacientes foram submetidos à drenagem biliar percutânea. A idade média foi de 64±16 anos (20-92), 38 eram homens e 44 mulheres. Os pacientes que apresentaram hemostasia alterada foram corrigidos, e a presença de complicações hemorrágicas foi avaliada com exames laboratoriais e ultrassonográficos. Resultados: Dos 82 pacientes, 23 necessitaram de correção da hemostasia. O acesso à direita foi em 41 casos, 30 à esquerda e 11 bilaterais. A quantidade de punções em média foi de 3±2. Houve 13 (15,8%) complicações hemorrágicas, 12 (20%) no grupo não corrigido e apenas uma (4,34%) no corrigido sem diferença estatística. Não houve diferenças no lado, no número de perfurações e no tipo de drenagem, mas o número de passagens e o tamanho da drenagem no lado direito foram diferentes. Não houve mortalidade. Conclusão: As complicações hemorrágicas em pacientes que necessitam de correção da hemostasia antes da drenagem biliar percutânea não são maiores do que naqueles que não a requerem.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Drainage/adverse effects , Cholestasis/surgery , Blood Loss, Surgical , Hemostasis , Intraoperative Complications/etiology , Punctures , Drainage/methods , Cholestasis/blood , Cross-Sectional Studies , Prospective Studies , Risk Factors , Catheters
Texto & contexto enferm ; 28: e20180129, 2019. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1014652


ABSTRACT Objective: to estimate the incidence of red blood cell concentrate orders in elective femur fracture repair surgeries and to identify predictors for hemotranfusion. Method: retrospective cohort study conducted with 271 patients submitted to femur fracture repair surgery between July 2013 and July 2016. Surgical and transfusion data were obtained from patient charts and the Transfusion Management System. Association between sociodemographic and clinical variables related to the surgical procedure and the occurrence of red blood cell concentrate transfusion was analyzed using descriptive statistics, the chi-squared test, relative risk, and odds ratio. Multivariate analysis was performed using binomial logistic regression. Results: the incidence of blood orders for patients undergoing femur fracture repair surgery was 87%. Ninety-one (33.6%) patients received red blood cell concentrate transfusions. Even though placing blood orders is recommended, given the possibility of intra- or postoperative transfusions, only 52 (47.2%) blood transfusions occurred in the preoperative period. The variables female sex, low preoperative hemoglobin levels and procedure lasting longer than 120 minutes presented statistical significance (p<0.05) and were considered predictors for hemototransfusion. Conclusion: Perioperative nursing must be aware of the importance of blood orders for all patients undergoing femur fracture repair surgery, including in the preoperative period, with special attention to patients who are female, previously anemic and submitted to long-lasting procedures.

RESUMEN Objetivo: estimar la incidencia de solicitud de reserva de concentrado de hematíes en cirugías electivas de corrección de fractura de fémur, e identificar los predictores para práctica de hemotransfusión. Método: Estudio de cohorte retrospectivo realizado con 271 pacientes sometidos a cirugía de corrección de fractura de fémur, entre julio de 2013 y julio de 2016. Datos quirúrgicos y de transfusiones obtenidos del análisis de historias clínicas y del Sistema de Gestión Transfusional. Se utilizó estadística descriptiva, test de chi-cuadrado, riesgo relativo y razón de oportunidades para analizar la asociación de variables sociodemográficas y clínicas referentes al procedimiento quirúrgico con transfusión de concentrado de hematíes. Para el análisis multivariado se utilizó regresión logística binomial. Resultados: la incidencia de solicitud de reserva para pacientes sometidos a cirugía de corrección de fractura de fémur resultó ser del 87,0%. y 91 (33,6) pacientes foram transfundidos con concentrado de hematíes. A pesar de la recomendación para solicitar reserva, considerando la posibilidad de transfusión intra o postoperatoria, 52 (47,2%) transfusiones se efectuaron en período preoperatorio. Existió significatividad estadística (p<0,05) para las variables: 5sexo femenino, bajos niveles de hemoglobina preoperatoria y duración del procedimiento superior a 120 minutos, considerados como predictores de la hemotransfusión. Conclusión: Resulta esencial que la enfermería perioperatoria tenga conocimiento de la importancia de la reserva sanguínea para todos los pacientes sometidos al tratamiento quirúrgico de la fractura de fémur, incluso en el preoperatorio, estando pendientes de los pacientes femeninos, con anemia previa y sometidos a procedimientos de larga duración.

RESUMO Objetivo: estimar a incidência da solicitação de reserva de concentrado de hemácias em cirurgias eletivas de correção de fratura de fêmur, e identificar os preditores para a ocorrência da hemotransfusão. Método: estudo de coorte retrospectivo realizado com 271 pacientes submetidos à cirurgia de correção de fratura de fêmur, no período de julho de 2013 a julho de 2016. Os dados cirúrgicos e transfusionais foram obtidos a partir da análise dos prontuários e do Sistema de Gestão Transfusional. Utilizou-se a estatística descritiva e, teste qui-quadrado, risco relativo, razão de chances para analisar a associação de variáveis sociodemográficas e clínicas, referentes ao procedimento cirúrgico, com a hemotransfusão de concentrado de hemácias. Para a análise multivariada utilizou-se a regressão logística binomial. Resultados: a incidência de solicitação de reserva para os pacientes submetidos à cirurgia de correção de fratura de fêmur foi de 87,0% e 91 (33,6%) pacientes foram transfundidos com concentrado de hemácias. Apesar da recomendação de solicitar reserva, tendo em vista a possibilidade de transfusão no intra ou pós-operatório, 52 (47,2%) transfusões ocorreram no período pré-operatório. Houve significância estatística (p<0,05) para as variáveis sexo feminino, nível baixo de hemoglobina pré-operatória e duração do procedimento superior a 120 minutos, considerados como preditores para a hemotransfusão. Conclusão: é fundamental que a enfermagem perioperatória tenha o conhecimento da importância da reserva sanguínea para todos os pacientes submetidos ao tratamento cirúrgico da fratura de fêmur, inclusive no pré-operatório, atentando para os pacientes do sexo feminino, previamente anêmicos e submetidos aos procedimentos de longa duração.

Humans , Blood Transfusion , Blood Loss, Surgical , Elective Surgical Procedures , Femoral Fractures , Patient Safety
Clinics ; 74: e946, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011912


OBJECTIVES: Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS: This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS: A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION: The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.

Humans , Female , Pregnancy , Adult , Young Adult , Uterine Hemorrhage/prevention & control , Uterus/surgery , Balloon Occlusion/methods , Uterine Artery Embolization/methods , Hysterectomy/adverse effects , Aorta, Abdominal , Placentation , Uterus/blood supply , Cesarean Section , Retrospective Studies , Blood Loss, Surgical/prevention & control , Combined Modality Therapy , Endovascular Procedures , Iliac Artery
Rev. Col. Bras. Cir ; 46(2): e2075, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1003083


RESUMO A artroplastia total do joelho é um procedimento eletivo, realizado em indivíduos relativamente saudáveis. Porém, devido ao risco inerente de tromboembolismo venoso, são utilizados fármacos para sua profilaxia. O objetivo do presente trabalho foi conduzir uma revisão sistemática da literatura para comparar a eficácia da enoxaparina e da rivaroxabana na prevenção desta complicação e no risco de sangramento intraoperatório. Foi feita uma revisão no site SciELO, Pubmed e Cochrane através dos descritores, artroplastia de joelho, rivaroxabana e enoxaparina através da estratégia de busca PICO. Os critérios de inclusão foram os artigos no período estudado, que comparavam ambas as drogas em cirurgias de artroplastia do joelho. Os critérios de relevância para tornar o estudo elegível foram definidos como: somente artigos publicados a partir 2010 e com casuística com mais de 20 pacientes foram considerados; somente estudos obtidos em sua íntegra foram analisados; somente estudos com seguimento maior do que 12 meses foram considerados relevantes. As variáveis utilizadas para a comparação dos artigos foram as complicações mais comuns no pós-operatório de artroplastias do joelho: tromboembolismo venoso e sangramento. Foi utilizado o Review Man 5.3 para estruturação da revisão. Os autores observaram que nos estudos analisados, considerando tromboembolismo venoso sintomático, a rivaroxabana resultou em maiores benefícios quando comparada com a enoxaparina.

ABSTRACT Total knee arthroplasty is an elective procedure performed on relatively healthy individuals. However, due to the inherent risk of venous thromboembolism, drugs are used for its prophylaxis. The objective of the present study was to conduct a systematic review of the literature to compare the efficacy of enoxaparin and rivaroxaban in preventing this complication and the risk of intraoperative bleeding. We reviewed the SciELO, Pubmed and Cochrane databases with the descriptors knee arthroplasty, rivaroxaban and enoxaparin through the PICO search strategy. Inclusion criteria were the articles during the study period comparing both drugs in knee arthroplasty. Relevant criteria to study eligibility were articles published since 2010 and with a sample of more than 20 patients; studies obtained in their entirety; and studies with follow-up of more than 12 months. The variables used to compare the articles were the most common postoperative complications of knee arthroplasties: venous thromboembolism and bleeding. We used the Review Man software, version 5.3, for structuring the review. In the studies analyzed, considering symptomatic venous thromboembolism, rivaroxaban resulted in higher benefits when compared to enoxaparin.

Humans , Postoperative Complications/prevention & control , Enoxaparin/therapeutic use , Arthroplasty, Replacement, Knee/adverse effects , Venous Thromboembolism/prevention & control , Rivaroxaban/therapeutic use , Anticoagulants/therapeutic use , Postoperative Complications/ethnology , Risk Factors , Blood Loss, Surgical , Treatment Outcome , Postoperative Hemorrhage/chemically induced , Venous Thromboembolism/ethnology