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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1468-1473, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191708

RESUMO

Objective: To review the advances in the application of tranexamic acid (TXA) in adolescent spinal corrective surgery. Methods: The mechanism of action and pharmacokinetic, effectiveness, dosage, safety as well as methods of administration were comprehensively summarized by consulting domestic and overseas related literature about the application of TXA in adolescent spinal corrective surgery in recent years. Results: TXA efficaciously reduce intraoperative blood loss, transfusion rate and volume, postoperative drainage volume in adolescent spinal corrective surgery. At present, the most common method of administration in adolescent spinal corrective surgery is that a loading dose is given intravenously before skin incision or induction of anesthesia, followed by a maintenance dose until the end of the surgery. The range of loading dose and maintenance dose is 10-100 mg/kg and 1-10 mg/(kg·h), respectively. No drug related adverse event has been reported in this range. Conclusion: The effectiveness and safety of TXA in adolescent spinal surgery have been basically confirmed. However, further studies are needed to determine the optimal dosage, method of administration as well as whether it could reduce blood loss after surgery.


Assuntos
Antifibrinolíticos , Ácido Tranexâmico , Adolescente , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Humanos , Período Pós-Operatório , Ácido Tranexâmico/uso terapêutico
2.
Medicine (Baltimore) ; 99(40): e21987, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019391

RESUMO

Intravenous fluid prescription is an essential part of postoperative care and may play a causal role in postoperative complications. The objective of the present study was to evaluate the relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of pediatric patients.This analysis included a retrospective review of 172 patients who underwent gastroenterological surgery from January 2012 to September 2018 at an academic tertiary care hospital. Patients were evaluated based on the median amount of corrected crystalloids and subsequently dichotomized as low (<25.89 mL/kg h) versus high (>25.89 mL/kg h). The primary outcome measure was the postoperative length of hospital stay (pLOS). Secondary outcome measures included the postoperative time to restore gastroenterological functions and postoperative complications.Patients who received larger amounts of crystalloids were more likely to have a lower intraoperative level of hemoglobin (P = .78) and an intraoperative blood transfusion (P = .27). There were trends toward lower incidence rates of hyperchloremic acidosis (P = .375) and metabolic acidosis (P = .54) in the high crystalloid administration cohort. The incidence of postoperative complications increased as the amount of administered fluid decreased (P = .046). The total length of hospital stay was shorter in patients who received high volumes of crystalloid fluid (19.5 [15.75-32.25] days) than in patients who received low volumes (22 [16-29.5] days, P = .283).Significant and multifaceted variability in crystalloid administration was noted among pediatric patients undergoing major surgery. High fluid administration was associated with favorable postoperative outcomes; these findings could be applied to improve patient safety and facilitate better quality of care.


Assuntos
Soluções Cristaloides/administração & dosagem , Enterocolite Necrosante/terapia , Hidratação/métodos , Administração Intravenosa , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Laparotomia/efeitos adversos , Laparotomia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(35): e21916, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871925

RESUMO

Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS.This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), whereas 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin and hematocrit. In addition, the baseline conditions of mother and neonates were compared.EBL was significantly higher in the IIA group compared to the control group (2883.5 mL in the IIA group vs 1868.7 mL in the control group, P = .001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 mL, in the IIA group versus 20%, averaging 816.7 mL, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 mL. In the control group, 90% had salvaged blood returned, averaging 617.9 mL. No cases of amniotic fluid embolism were observed with leukocyte depletion filters.Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.


Assuntos
Oclusão com Balão/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/métodos , Cesárea/métodos , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Útero/cirurgia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia , Artéria Ilíaca , Recuperação de Sangue Operatório , Gravidez , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(36): e22028, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899057

RESUMO

Comparison of different anticoagulants in blood management and complications with tranexamic acid (TXA) in total hip arthroplasty (THA) is unclear. Our aim was to compare the efficacy and safety among receiving nadroparin calcium, enoxaparin sodium or rivaroxaban after TXA in THA.150 patients undergoing primary unilateral THA were received 15 mg/kg intravenous TXA (IV-TXA) before skin incision, followed by 1 of nadroparin calcium (Group A), enoxaparin sodium (Group B), or rivaroxaban (Group C) randomly during hospitalization. The primary outcome was hidden blood loss (HBL). Other outcomes such as the maximum hemoglobin (Hb) drop, total blood loss (TBL), the volume of drainage, transfusion rate, length of hospital stay (LOS), and complications were also compared.There were no statistically significant differences in HBL, the maximum hemoglobin (Hb) drop, transfusion rate, and complications among 3 groups. LOS was significantly higher for patients in Group B than Group A (P = .026). Neither deep venous thrombosis (DVT) nor pulmonary embolism (PE) occurred in any group.There were no differences in efficacy and safety in patients undergoing THA receiving nadroparin calcium, enoxaparin sodium, or rivaroxaban after anti-fibrinolysis with TXA.


Assuntos
Anticoagulantes/efeitos adversos , Antifibrinolíticos/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Ácido Tranexâmico/efeitos adversos , Administração Intravenosa , Idoso , Anticoagulantes/administração & dosagem , Antifibrinolíticos/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , China/epidemiologia , Enoxaparina/administração & dosagem , Enoxaparina/efeitos adversos , Feminino , Hemoglobinas/análise , Hospitalização , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Nadroparina/administração & dosagem , Nadroparina/efeitos adversos , Sangue Oculto , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Segurança , Ácido Tranexâmico/administração & dosagem , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(37): e22069, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925743

RESUMO

OBJECTIVE: Long-segment spinal fusion surgery was associated with substantial perioperative blood loss which may increase hospitalization expenses and mortality rates. Substantial studies have reported that tranexamic acid (TXA) could reduce blood products and cost after joint arthroplasty surgery. However, there still exists controversy regarding the efficacy of TXA in long-segment spinal fusion surgery. We performed this protocol to design a randomized controlled study to evaluate the efficacy of TXA in decreasing transfusion rate of allogeneic blood products and transfusion cost in degenerative lumbar scoliosis patients. METHODS: This study was carried out as a double-blinded, randomized clinical trial on patients with degenerative lumbar scoliosis who prepared for long-segment spinal fusion surgery from December 2018 to December 2019. It was authorized via the Institutional Review Committee in Southwest Medical University (ky2019225). Eighty patients were divided randomly into 2 groups (Experimental group = 40, control group = 40). The patients in the experimental group received 1000 mg of TXA mixed in 100 mL normal saline as a single dose intravenously over 20 minutes before the skin incision was made. Control group received equivalent normal saline without TXA. Primary outcomes included total blood loss, estimated intraoperative blood loss, hematocrit and hemoglobin decline, postoperative drain amount, intra-/postoperative allogeneic transfusion amount and rate, and total transfusion cost. Secondary outcomes included surgical time, thrombotic complications including deep vein thrombosis and pulmonary embolism. All the needed analyses were implemented through utilizing SPSS for Windows Version 20.0. RESULTS: Table showed the relevant clinical outcomes between experimental group and control group. CONCLUSION: We hypothesized that TXA was effective and safe in reducing blood transfusion and cost in long-segment spinal fusion surgery. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5854).


Assuntos
Antifibrinolíticos/uso terapêutico , Transfusão de Sangue , Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Ácido Tranexâmico/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Método Duplo-Cego , Feminino , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Hemorragia Pós-Operatória/prevenção & controle , Embolia Pulmonar , Fusão Vertebral/efeitos adversos , Trombose Venosa
6.
Orv Hetil ; 161(37): 1554-1568, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894735

RESUMO

The perioperative Patient Blood Management (in Hungary National Blood Donation and Blood Saving Program) is an individualized clinical practice based on a multidisciplinary consensus with a comprehensive and complex approach. It supports the rational and judicious utilization of blood products and abolishes irrational transfusion policy. Its practical implementation is based upon three pillars: 1. anemia management without transfusion, if possible; restrictive transfusion strategy; 2. minimization of blood loss; 3. enhancement of anemia tolerance. Early detection, clarification of etiology and appropriate treatment are the most important tools for the management of preoperative anemia before surgeries with a high risk of bleeding. Minimization of blood loss can be achieved by identifying patients with congenital or acquired bleeding disorders, preparing them appropriately for surgery, discontinuing anticoagulants and antiplatelet drugs for a sufficient time in the preoperative phase of surgery and reversing their effects to comply with current guidelines. Minimal-invasive approaches are preferable. Intraoperatively, atraumatic technique and accurate topical haemostasis should be provided by surgeons. Autologous blood salvage techniques and controlled hypotension in lack of contraindications can also reduce the amount of blood loss. In cases of perioperative bleeding, protocols based on international guidelines but adapted to local circumstances must be used. Ideally, it should be managed by viscoelastic test-guided, goal-directed, individualized and factor concentrate-based algorithm. Perioperatively, an ideal oxygen demand/supply ratio must be ensured to avoid oxygen debt. Restoration and maintenance of homeostasis are essential for both the effectively functioning haemostatic system and the avoidance of oxygen deficit. Implementation of the Patient Blood Management improves patient safety, reduces the cost of medical care and facilitates the national blood product supply. Its successful introduction is our common interest. Orv Hetil. 2020; 161(37): 1554-1568.


Assuntos
Anemia , Perda Sanguínea Cirúrgica , Hemostáticos , Assistência Perioperatória , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Hemorragia , Humanos , Hungria
7.
Bone Joint J ; 102-B(9): 1151-1157, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862676

RESUMO

AIMS: Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion requirements in patients undergoing orthopaedic surgery. There remains a lack of prospective evidence for the use of TXA in patients undergoing periacetabular osteotomy (PAO). The purpose of this study was to determine if intravenous (IV) TXA is effective in reducing calculated blood loss and transfusions after PAO. METHODS: This was a single-centre prospective double-blind placebo-controlled randomized trial of 81 patients aged 12 to 45 years undergoing elective PAO by a single surgeon. The intervention group (n = 40) received two doses of IV TXA of a maximum 1 g in each dose; the control group (n = 41) received two doses of 50 ml 0.9% saline IV. The primary outcome was perioperative calculated blood loss. Secondary outcomes included allogenic transfusions and six-week postoperative complications. RESULTS: There were no differences in demographics or intraoperative variables between study groups. The TXA group demonstrated lower mean calculated blood loss (1,265 ml, (SD 321) vs 1,515 ml, (SD 394); p = 0.002) and lower frequency of allogenic transfusion (10%/n = 4 vs 37%/n = 15; p = 0.008). Regression analyses associated TXA use with significant reductions in calculated blood loss (p < 0.001) and transfusion (p = 0.007) after adjusting for age, sex, body mass index, preoperative haemoglobin, cell-saver volume, intraoperative mean arterial blood pressure, and operating time. No patients suffered venous thromboembolic complications. CONCLUSION: In this trial, IV TXA decreased postoperative calculated blood loss by 293 ml and reduced the frequency of allogenic transfusions by 73% (37% vs 10%) following PAO. TXA may be safe and effective for reducing blood loss in patients undergoing PAO. Cite this article: Bone Joint J 2020;102-B(9):1151-1157.


Assuntos
Acetábulo/cirurgia , Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/estatística & dados numéricos , Osteotomia , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Administração Intravenosa , Adolescente , Adulto , Criança , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
8.
Khirurgiia (Mosk) ; (8): 61-68, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869617

RESUMO

OBJECTIVE: To analyze an opinion of surgeons on advisability, efficacy and choice of topical hemostatic agents. MATERIAL AND METHODS: The research was based on anonymous questioning of surgeons. The questionnaires were developed by using of interactive Google Forms tool (https://www.google.ru/forms). Distribution of questionnaires and invitation of respondents to participation in research were carried out through the Internet. RESULTS: The study enrolled 135 surgeons. Colleagues with considerable experience and length of surgical practice prevailed: 10-15 years - 16 people; 15-20 years - 22 people; over 20 years - 38 people. Opinion of less experienced surgeons was also considered: less than 5 years - 40 people; 5-10 years - 19 people. General surgeons prevailed (49%). Hemostatic sutures (30%) and application of topical hemostatic agents (27%) were the most common methods to stop parenchymal bleeding. Efficacy of local hemostatics is confirmed by small number of cases of recurrent intraoperative bleeding (n=24). Thirty-four respondents reported recurrent bleeding after hemostasis by conventional methods. Postoperative suppuration of hemostatic implant was noted by 9.5% of respondents. Most respondents (77%) prefer combination of hemostatic implants and other traditional methods of hemostasis. CONCLUSION: According to surgeons' opinion, local hemostatic agents are effective for parenchymal bleeding. This method may be used as basic (injury grade I by E. Moore classification) or additional method of hemostasis (grade I-III). Many respondents consider that application of topical hemostatic agent after imposing hemostatic sutures ensures the greatest efficiency of hemostasis. Moreover, placement of the agent over or under sutures seems to be the most advisable.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Hemostáticos/administração & dosagem , Técnicas de Sutura , Administração Tópica , Pesquisas sobre Serviços de Saúde , Humanos , Internet , Recidiva
9.
J Extra Corpor Technol ; 52(3): 182-190, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32981955

RESUMO

Intraoperative cell salvage (ICS) is a critical component of any blood management program involving surgery with a high potential for blood loss. The introduction of antifibrinolytics (AF) may reduce blood loss. The purpose of this study was to evaluate the use of AF on ICS in non-cardiac surgical procedures. Following institutional review board approval, 69,935 consecutive case records between January 2016 and September 2019 from a national registry of adult surgical patients were reviewed. Procedure types were stratified into one of nine surgical categories: general (GN, n = 1,525), neurosurgical (NS, n = 479), obstetric (OB, n = 1,563), cervical spine (CS, n = 2,701), lumbar spine (LS, n = 38,383), hip arthroplasty (HA, n = 13,327), knee arthroplasty (KA, n = 596), vascular (VA, n = 9,845), or orthopedic other (OO, n = 1,516). The primary endpoint was the use of AF with the secondary endpoints ICS shed blood volume and volume available for return. The overall use of AF across all surgical procedures increased from 21.4% in 2016 to 25.4% in 2019. The greatest increases were seen in NS (4.4% to 16.2%), LS (13.7% to 23.1%), and HA (55.8% to 61.9%). For several procedure types, there was an initial increase then either a leveling off or a decline in AF use: OB initially increased from 6.2% to 10.8% in 2018, whereas GN (9.4% to 7.2%) and VA surgery declined slightly (9.9% to 5.7%). When comparing patients who did not receive AF with those who did, there were similar volumes of ICS available for return in all groups, except for LS, GN, and VA, where lower volumes were seen in the No-AF groups. The use of AF has increased each year over the 4-year period in most of the surgical categories, but several have declined. There may be a beneficial effect of AF with lower ICS volumes available for return in a few groups.


Assuntos
Antifibrinolíticos , Adulto , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Gravidez , Sistema de Registros
10.
Khirurgiia (Mosk) ; (7): 111-118, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736475

RESUMO

The researches devoted to blood-saving technologies in extensive liver resections are analyzed in the manuscript. Resection of three and more liver segments is effective method of surgical treatment of various focal liver lesions. Surgical (anatomical resection with hilar glissonean access, Pringle maneuver, modern technical equipment, etc.), anesthesiological (reduction of central venous pressure, hemostatic agents) and transfusion (autologous blood donation, transfusion, cell saver, etc.) methods contribute to prevention and reduction of blood loss. Intraoperative measures for blood loss prevention should include adequate surgical incision and liver mobilization, precise techniques of parenchymal dissection (for example, cavitation surgical aspirator-destructor), use of clip applicators and local or systemic hemostatic agents.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Hepatectomia/métodos , Hepatopatias/cirurgia , Fígado/cirurgia , Humanos , Fígado/irrigação sanguínea , Recuperação de Sangue Operatório/métodos
11.
Zhonghua Fu Chan Ke Za Zhi ; 55(7): 450-456, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842248

RESUMO

Objective: To access the effectiveness and safety of the intrauterine balloon tamponade verse gauze packing combined with temporary abdominal aortic balloon occlusion in the management of placenta accreta spectrum (PAS). Methods: This was an open-label, randomized controlled trial conducted in Nanjing Drum Tower Hospital. The patients suspected with PAS for uterine preservation surgery under the multidisciplinary team care were recruited between Aug 2015 and Jan 2018. When bleeding could not be achieved after fetus delivered, and a temporary abdominal aortic balloon occlusion and the compression sutures as needed, the women were randomly allocated 1∶1 into balloon tamponade (n=81) or gauze packing (n=80) group. The primary outcome was successful bleeding arrests by avoiding second line surgeries. The secondary outcomes included the volume of blood loss during and after cesarean section, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, postpartum pain, ICU admission, need for re-laparotomy, and the length of hospital stay, readmission, and interventional radiology complications. Results: All the women [100% (81/81)] in the balloon group were obtained hemostasis without further intervention, significantly higher than 88% (70/80) in the gauze group (P=0.001). Before uterine tamponade, blood loss were 820 ml (620-1 230) ml and 850 ml (605-1 442) ml, while placenta bed were sutured in 96%(78/81, 77/80) respectively (P>0.05).The proportion of blood loss≥1 000 ml was higher in the gauze group than that in the balloon group (P=0.006). Maternal adverse events involving total blood loss, puerperal morbidity and postpartum pain occurred more frequently in the gauze group (P<0.05). The following outcome showed no statistically significant difference between the two groups: the vascular occlusion time, the dose of radiation, and interventional radiology complication (P>0.05). The median volume infused into the lower and upper balloons is 70 ml (50-100 ml) and 180 ml (100-240 ml). Conclusions: Incrauterine balloon tamponade is as effective as gauze packing in hemostasis following the placenta delivery in PAS. Compared with gauze packing, the uterine balloon tamponade is more effective.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/estatística & dados numéricos , Placenta Acreta/terapia , Hemorragia Pós-Parto/prevenção & controle , Tamponamento com Balão Uterino/métodos , Aorta Abdominal , Oclusão com Balão/métodos , Transfusão de Sangue , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia , Incidência , Placenta Prévia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
12.
Chin J Traumatol ; 23(5): 302-306, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32855045

RESUMO

PURPOSE: To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia. METHODS: The study included patients who were diagnosed with long-term chronic infected tibial nonunion following trauma and treated with the two-stage technique between January 2010 and November 2017. Patients with (1) intra-articular fractures of the distal third of the tibia and fibula, (2) pathological fracture resulting in bone loss or (3) neurological and vascular pathologies of the limbs were excluded. The operation consisted of two stages and the main goal in the first stage was to control the infection and in the second stage to control the healing of the bone. Functional & radiographic results and complications were evaluated according to Paley's criteria. RESULTS: The patients comprised 14 males and 5 females with a mean age of 37.4 years (range, 21-52 years). Patients were followed up for an average of 27 months (range, 15-38 months). The microorganisms produced from these patients were Staphylococcus aureus in 13 patients, Pseudomonas aeruginosa in 4 patients and no bacteria in 2 patients. After the first stage operation, superficial skin necrosis developed in 1 patient. In another patient, there was a persistent infection, although union was achieved. For the entire patient group, union was observed at the end of 7.44 months (range, 7-11 months). Based on Paley's criteria, there were 16 (84.2%) patients with excellent scores, 2 (10.5%) good scores and 1 (5.3%) fair scores radiologically; while regarding the tibial function, 15 (78.9%) patients had excellent scores, 3 (15.8%) good scores, and 1 (5.3%) fair scores. No patients had poor radiological or functional score. CONCLUSION: Two-stage treatment can be considered as an alternative for fractures in regions that are susceptible to many and persistent complications, such as the tibia. This technique has the advantages of short operation time, minimal blood loss, no excessive tissue damage and not very technique-demanding (a short learning curve with no requirement for an experienced team).


Assuntos
Doenças Ósseas Infecciosas/cirurgia , Fraturas não Consolidadas/cirurgia , Procedimentos Ortopédicos/métodos , Osteíte/cirurgia , Retalhos Cirúrgicos , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Doença Crônica , Feminino , Fíbula , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Adulto Jovem
13.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 105-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856448

RESUMO

The aim of the present study was to evaluate the efficacy of topical versus combined (intravenous + topical) tranexamic acid (TXA) to reduce perioperative blood loss after uncemented primary total hip arthroplasty (THA). Seventy-five patients were randomized in three comparable experimental groups: 1) topical TXA (3 g in 50 ml of saline solution); 2) intravenous + topical TXA (3 g topical + 2 g in 100 ml of saline solution intravenously); 3) controls. Pre- and post-operative hemoglobin (Hb) levels and hematocrit (Hct) values along with the rate of blood transfusion in the 3 groups were compared. The intravenous + topical TXA group demonstrated higher Hb levels and Hct values at postoperative day one (Hb = p <0.05, Hct = p <0.001), postoperative day three (Hb = p <0.05, Hct = p <0.001), and discharge (Hct = p <0.01) compared to the control group. The intravenous + topical group had a lower transfusion rate compared to the control group (0% vs 20%, p = 0.014). With the numbers available, no difference in postoperative Hb level and transfusion rate emerged between topical TXA and control group.


Assuntos
Artroplastia de Quadril , Administração Tópica , Antifibrinolíticos , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Ácido Tranexâmico
15.
Zhonghua Wai Ke Za Zhi ; 58(7): 555-557, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610427

RESUMO

An estimate of about 50% of new liver cancer cases worldwide occur in China every year.Surgical resection is still the major treatment choice for longer survival of patients with hepatocellular carcinoma. Blocking hepatic blood flow and reducing intraoperative bleeding ensure the success of the operation. Anatomic separation of hepatic hilar region is the precondition of hepatic inflow occlusion. The hepatic hilar plate system involves a thick layer of connective tissue covering the hepatic inflow ducts of hepatic hilar region. The descending part of hilar plate assists in reducing the anatomical difficulty of the hepatic hilar region. The "forth porta hepatis" that is hidden in the hepatic hilar plate system involves the accumulation area of "short hepatic portal veins" .The communicating branch vessels between the hepatic inflow vessels form the anatomical basis in reducing the indocyanine green fluorescence stain effect.The relatively fixed position of the hepatic portal plate is considered as a positioning marker for accurate liver resection. The intrahepatic Glisson sheath is connected with thick connective tissue of the hepatic portal panel system, and is regarded as the physical barrier in limiting the proliferation and hypertrophy of hepatocytes and continuation of hepatic portal panel system in the liver.This paper summarizes the anatomy and application of hepatic hilar plate system during hepatobiliary surgery.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/anatomia & histologia , Fígado/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , China , Tecido Conjuntivo/anatomia & histologia , Tecido Conjuntivo/cirurgia , Hepatectomia/efeitos adversos , Humanos , Fígado/irrigação sanguínea , Veia Porta/anatomia & histologia , Veia Porta/cirurgia
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 683-688, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683830

RESUMO

Objective: To explore the effects of the application of membrane anatomy concept in sleeve gastrectomy on postoperative nausea and vomiting (PONV) in patients with obesity or metabolic diseases. Methods: A retrospective cohort study was conducted. Clinical data of 88 patients with obesity or metabolic diseases who underwent laparoscopic sleeve gastrectomy in The First Affiliated Hospital of Jinan University from September 2018 to June 2019 were retrospectively analyzed. Forty patients underwent sleeve gastrectomy with membrane anatomy concept as membrane anatomy group, and the other 48 patients underwent traditional sleeve gastrectomy as traditional operation group. There were no significant differences in baseline data between the two groups (all P>0.05). The PONV score of and the times of antiemetic drugs used during 0-6 h and 6-24 h after operation were compared between the two groups. Higher PONV represents more serious nause and vomiting, the score ≥5 is defined as clinical significant PONV. Results: All patients of the two groups successfully completed the operation, and there was no conversion to open, reoperation, and operation-related death. The intraoperative blood loss in the membrane anatomy group was significantly less than that in the traditional surgery group [median: 5.0 (5.0, 5.8) ml vs. 10.0 (5.0, 10.0) ml, Z=-3.265, P=0.001]. There were no significant differences between the two groups in terms of operative time, postoperative hospital stay, gastroesophageal reflux, pain score and postoperative complications (all P>0.05). There was no postoperative bleeding or gastric leakage in either groups. There were no significant differences in PONV score, incidence of clinically significant PONV and use of antiemetics 0-6 h after operation between two groups (all P>0.05). From 6 to 24 hours after operation, compared with traditional surgery group, the membrane anatomy group had lower PONV score (4.6±0.9 vs. 5.1±0.7, t=-2.192, P=0.007), lower incidence of clinically significant PONV [55.0% (22/40) vs. 83.3% (40/48), χ(2)=8.414, P=0.004] and less use of antiemetics [3 times: 10.0% (4/40) vs. 27.1% (13/48), Z=-2.880, P=0.004]. Postoperative follow-up ranged from 1 to 6 months (median 3), 32 cases in membranous anatomy group and 38 cases in the traditional operation group were followed up. One case in the traditional operation group received symptomatic treatment in the local hospital due to functional intestinal obstruction 1 month after surgery and was discharged after recovery. The remaining patients had no postoperative complications and were not readmitted to hospital. Conclusion: Sleeve gastrectomy based on membrane anatomy in the treatment of patients with obesity or metabolic syndrome can make surgical procedure more precise and meticulous, reduce the intraoperative bleeding and the incidence of PONV.


Assuntos
Gastrectomia/efeitos adversos , Gastrectomia/métodos , Doenças Metabólicas/cirurgia , Obesidade/cirurgia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Peritônio/anatomia & histologia , Peritônio/cirurgia , Náusea e Vômito Pós-Operatórios/etiologia , Estudos Retrospectivos
17.
Br J Anaesth ; 125(3): 336-345, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620262

RESUMO

BACKGROUND: Tranexamic acid (TXA) reduces blood loss and transfusion in paediatric craniosynostosis surgery. The hypothesis is that low-dose TXA, determined by pharmacokinetic modelling, is non-inferior to high-dose TXA in decreasing blood loss and transfusion in children. METHODS: Children undergoing craniosynostosis surgery were enrolled in a two-centre, prospective, double-blind, randomised, non-inferiority controlled trial to receive high TXA (50 mg kg-1 followed by 5 mg kg-1 h-1) or low TXA (10 mg kg-1 followed by 5 mg kg-1 h-1). Primary outcome was blood loss. Low dose was determined to be non-inferior to high dose if the 95% confidence interval (CI) for the mean difference in blood loss was above the non-inferiority margin of -20 ml kg-1. Secondary outcomes were transfusion, TXA plasma concentrations, and biological markers of fibrinolysis and inflammation. RESULTS: Sixty-eight children were included. Values were non-inferior regarding blood loss (39.4 [4.4] vs 40.3 [6.2] ml kg-1 [difference=0.9; 95% CI: -14.2, 15.9]) and blood transfusion (21.3 [1.6] vs 23.6 [1.5] ml kg-1 [difference=2.3; 95% CI: -2.1, 6.7]) between high-dose (n=32) and low-dose (n=34) groups, respectively. The TXA plasma concentrations during surgery averaged 50.2 (8.0) and 29.6 (7.6) µg ml-1. There was no difference in fibrinolytic and inflammatory biological marker concentrations. No adverse events were observed. CONCLUSIONS: Tranexamic acid 10 mg kg-1 followed by 5 mg kg-1 h-1 is not less effective than a higher dose of 50 mg kg-1 and 5 mg kg-1 h-1 in reducing blood loss and transfusion in paediatric craniosynostosis surgery. CLINICAL TRIAL REGISTRATION: NCT02188576.


Assuntos
Antifibrinolíticos/uso terapêutico , Craniossinostoses/cirurgia , Ácido Tranexâmico/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Pré-Escolar , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos
18.
Ann Surg ; 272(2): 220-226, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675485

RESUMO

OBJECTIVE: To develop and evaluate a novel instrument to measure SEVERE processes using video data. BACKGROUND: Surgical video data can serve an important role in understanding the relationship between intraoperative events and postoperative outcomes. However, a standard tool to measure severity of intraoperative events is not yet available. METHODS: Items to be included in the instrument were identified through literature and video reviews. A committee of experts guided item reduction, including pilot tests and revisions, and determined weighted scores. Content validity was evaluated using a validated sensibility questionnaire. Inter-rater reliability was assessed by calculating intraclass correlation coefficient. Construct validity was evaluated on a sample of 120 patients who underwent laparoscopic Roux-en-Y gastric bypass procedure, in which comprehensive video data was obtained. RESULTS: SEVERE index measures severity of 5 event types using ordinal scales. Each intraoperative event is given a weighted score out of 10. Inter-rater reliability was excellent [0.87 (95%-confidence interval, 0.77-0.92)]. In a sample of consecutive 120 patients undergoing gastric bypass procedures, a median of 12 events [interquartile range (IQR) 9-18] occurred per patient and bleeding was the most frequent type (median 10, IQR 7-14). The median SEVERE score per case was 11.3 (IQR 8.3-16.9). In risk-adjusted multivariable regression models, history of previous abdominal surgery (P = 0.02) and body mass index (P = 0.005) were associated with SEVERE scores, demonstrating construct validity evidence. CONCLUSION: The SEVERE index may prove to be a useful instrument in identifying patients with high risk of developing postoperative complications.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endoscopia Gastrointestinal/métodos , Complicações Intraoperatórias/diagnóstico , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Gravação em Vídeo , Centros Médicos Acadêmicos , Adulto , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Ontário , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Resultado do Tratamento
19.
Eur J Vasc Endovasc Surg ; 60(3): 469-478, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32620348

RESUMO

OBJECTIVE: In vascular and cardiac surgery, the ability to maintain haemostasis and seal haemorrhagic tissues is key. Fibrin and thrombin based sealants were introduced as a means to prevent or halt bleeding during surgery. Whether fibrin and thrombin sealants affect surgical outcomes is poorly established. A systematic review and meta-analysis was performed to examine the impact of fibrin or thrombin sealants on patient outcomes in vascular and cardiac surgery. DATA SOURCES: Cochrane CENTRAL, Embase, and MEDLINE, as well as trial registries, conference abstracts, and reference lists of included articles were searched from inception to December 2019. REVIEW METHODS: Studies comparing the use of fibrin or thrombin sealant with either an active (other haemostatic methods) or standard surgical haemostatic control in vascular and cardiac surgery were searched for. The Cochrane risk of bias tool and the ROBINS-I tool (Risk Of Bias In Non-randomised Studies - of Interventions) were used to assess the risk of bias of the included randomised and non-randomised studies; quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Two reviewers screened studies, assessed risk of bias, and extracted data independently and in duplicate. Data from included trials were pooled using a random effects model. RESULTS: Twenty-one studies (n = 7 622 patients) were included: 13 randomised controlled trials (RCTs), five retrospective, and three prospective cohort studies. Meta-analysis of the RCTs showed a statistically significant decrease in the volume of blood lost (mean difference 120.7 mL, in favour of sealant use [95% confidence interval {CI} -150.6 - -90.7; p < .001], moderate quality). Time to haemostasis was also shown to be reduced in patients receiving sealant (mean difference -2.5 minutes [95% CI -4.0 - -1.1; p < .001], low quality). Post-operative blood transfusions, re-operation due to bleeding, and 30 day mortality were not significantly different for either RCTs or observational data. CONCLUSION: The use of fibrin and thrombin sealants confers a statistically significant but clinically small reduction in blood loss and time to haemostasis; it does not reduce blood transfusion. These Results may support selective rather than routine use of fibrin and thrombin sealants in vascular and cardiac surgery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos , Adesivo Tecidual de Fibrina/administração & dosagem , Hemostasia , Hemostáticos/administração & dosagem , Hemorragia Pós-Operatória/prevenção & controle , Trombina/administração & dosagem , Adesivos Teciduais/administração & dosagem , Procedimentos Cirúrgicos Vasculares , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Adesivo Tecidual de Fibrina/efeitos adversos , Hemostáticos/efeitos adversos , Humanos , Hemorragia Pós-Operatória/etiologia , Fatores de Risco , Trombina/efeitos adversos , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
20.
Medicine (Baltimore) ; 99(24): e20619, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541498

RESUMO

BACKGROUND: Questions still remain about the safest and most effective route of administration for tranexamic acid (TXA) in lumbar interbody fusion. As such, the goal of this randomized clinical trial was to assess the efficacy and safety of topical TXA compared with intravenous TXA in lumbar interbody fusion. METHODS: This was a prospectively randomized trial that investigated the effectiveness and safety of the intravenous and topical administrations of TXA with regard to lumbar interbody fusion. Approval from Clinical Studies Ethical Committee in our hospital was obtained. The patients were randomized to 1 of 2 treatment options:Patients, surgeons, anesthesiologists, nurses, and research assistants collecting data were blinded to group allocation. The primary outcome measures were perioperative calculated blood loss, total drain output at 24 hours, and perioperative blood transfusion rate. Secondary outcomes included an analysis of complications, namely symptomatic venous thromboembolism, cerebrovascular accident, and arterio-occlusive events. Data were analyzed using the statistical software package SPSS version 25.0 (Chicago, IL). RESULTS: There are several limitations to this study. We did not include a group of patients who did not receive TXA. Another potential limitation is that the study population contains heterogeneity such as varying patient diagnosis and surgical technique/approach. Despite these limitations, the validity of our results should be maintained, as the same methodology was applied to both treatment arms. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5564).


Assuntos
Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Fusão Vertebral , Ácido Tranexâmico/administração & dosagem , Administração Intravenosa , Administração Tópica , Antifibrinolíticos/efeitos adversos , Método Duplo-Cego , Humanos , Estudos Prospectivos , Ácido Tranexâmico/efeitos adversos , Resultado do Tratamento
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