Effect of tranexamic acid combined with rivaroxaban on perioperative blood loss in patients undergoing posterior lumbar interbody fusion and its benefits / 中国基层医药

Objective:To investigate the effect of tranexamic acid combined with rivaroxaban on perioperative blood loss in patients undergoing posterior lumbar interbody fusion and its potential benefits.Methods:This is a retrospective study. The clinical data of 90 patients who underwent posterior lumbar interbody fusion for lumbar spinal stenosis or spondylolisthesis at Affiliated Hospital of Jining Medical University between September 2019 and September 2021 were analyzed. These patients were divided into two groups: group A ( n = 46) and group B ( n = 44) based on their medication. Patients in group A received an intravenous infusion of 0.5 g tranexamic acid and 100 mL of 5% glucose injection 15 minutes before the surgical incision. The incision wound was soaked externally with 1 g of tranexamic acid solution for 5 minutes before the surgical incision was closed, and it was suctioned before its closure. Patients in group B received the same procedure, except that oral rivaroxaban was administered 10 mg, once daily, after surgery till 35 days after surgery. The operative time, intraoperative blood loss, and the amount of drainage were recorded. Total blood loss, occult blood loss, incidence of lower extremity deep vein thrombosis, incidence of pulmonary embolism and epidural hematoma, and C-reactive protein levels were determined. Results:There were no significant differences in operative time, intraoperative blood loss, the amount of drainage, total blood loss, and occult blood loss between the two groups (all P > 0.05). Postoperative C-reactive protein levels in group A [29.94 (15.75, 50.25) mg/L] were significantly higher than those in group B [7.89 (4.94, 11.10) mg/L, Z = -5.68; P < 0.05]. Lower extremity deep vein thrombosis, pulmonary embolism, or epidural hematoma did not occur in either group. In group A, one patient was infused with 200 mL of leucodepleted red blood cell suspension, while the other patient received 150 mL of autologous blood transfusion. In group B, two patients were infused with 525 mL and 200 mL of leucodepleted red blood cell suspensions, respectively, while the rest did not require blood transfusion. Conclusion:The combined use of tranexamic acid and rivaroxaban after posterior lumbar interbody fusion does not increase perioperative bleeding, and it has additional anti-inflammatory effects without increasing the incidence of lower extremity deep vein thrombosis and pulmonary embolism, as well as the formation of epidural hematomas and the need for blood transfusion.

Stages and factors of the "perioperative process": points in common with the aeronautical industry / Etapas e fatores do "processo perioperatório": pontos em comum com a indústria aeronáutica

ABSTRACT Background: The aeronautical industry is one of the disciplines that most use control systems. Its purpose is to avoid accidents and return safer flights. The flight of an airplane, from its takeoff to its landing is a process divided into stages under strict control. A surgical procedure has the same characteristics. We try to identify and develop the stages of the surgical process using the experience of the aviation industry in order to optimize the results and reduce surgical complications. Aim: To identify and develop the stages of the surgical process so that they could be applied to surgery departments. Methods: A search, review and bibliographic analysis of the application of aeronautical control and safety to medical practice in general and to surgery, in particular, were carried out. Results: Surgical process comprises the perioperative period. It is composed of Preoperative Stage (it is divided into 2 "sub-steps": hospital admission and control of preoperative studies) Operative Stage (it is divided into 3 "sub-steps": anesthetic induction, surgery, and anesthetic recovery) and Postoperative Stage (it is divided into 2 "sub-steps": control during hospitalization and ambulatory control). Two checkpoints must be developed. Checkpoint #1 would be located between the preoperative and operative stages, and checkpoint #2 would be located between the operative and postoperative stages. Surgical factors are surgeons, instrumental and technology, anesthesiology and operating room environment. Conclusion: It is possible and necessary to develop a systematic surgical procedure. Its application in the department of surgery could optimize the results and reduce the complications and errors related to daily practice.

RESUMO Racional: A indústria aeronáutica é uma das disciplinas que mais utiliza sistemas de controle. Sua finalidade é evitar acidentes e retornar voos mais seguros. O voo de um avião, desde a decolagem até a aterrissagem, é processo dividido em etapas com estrito controle. Um procedimento cirúrgico tem as mesmas características. Tentar identificar e desenvolver etapas no processo cirúrgico, utilizando a experiência da indústria aeronáutica, poderá otimizar os resultados e reduzir as complicações cirúrgicas. Objetivo: Identificar e desenvolver etapas no processo cirúrgico para que possam ser aplicadas nos serviços de cirurgia. Métodos: Foram realizadas pesquisas, revisão e análise bibliográfica sobre o controle e segurança aeronáutica e aplicando-as na prática médica em geral e à cirurgia em particular. Resultados: O processo cirúrgico compreende o período perioperatório. É composto de pré-operatório (dividido em duas sub-etapas: admissão hospitalar e controle de estudos pré-operatórios); fase operatória (dividida em três sub-etapas: indução anestésica, operação e recuperação anestésica) e fase pós-operatória (dividida em duas "sub-etapas": controle durante a hospitalização e controle ambulatorial). Dois pontos de verificação devem ser desenvolvidos. O ponto de checagem nº 1 estaria localizado entre os estágios pré-operatório e operatório, e o ponto de checagem nº 2 entre os estágios operatório e pós-operatório. Fatores cirúrgicos são cirurgiões, instrumental e tecnologia, anestesiologia e ambiente de sala de cirurgia. Conclusão: É possível e necessário desenvolver um procedimento cirúrgico sistemático. Sua aplicação no departamento de cirurgia poderia otimizar os resultados e reduzir as complicações e erros relacionados à prática diária.

Perioperative management of abdoimal surgery in over aged patients / 中国普通外科杂志

Objective To study the perioperative management of abdominal surgery in patients aged over 80 years. Methods The cliuical data of 25 patients aged over 80 years undergoing abdominal surgery were analysed retrospectively. Results Of the 25 patients, 8 subjected to biliary surgery, 13 gastiic cancer or cardiac cancer surgery, 1 esophageal cancer surgery, 3 intestinal surgery. 24 patients(96%) were cured; one died postoperalively.Conclusions In over aged patieats, they have more coexite diseases, and more postoperative complications, so extensive perioperative management, choice of selective operation, reducing of emergent operation, and giving albumin to help the recovery of tissues are essential.