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1.
Ann R Coll Surg Engl ; 102(1): 9-13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31755732

RESUMO

INTRODUCTION: An increasing number of patients are taking oral antiplatelet agents. As a result, there is an important patient safety concern in relation to the potential risk of bleeding complications following major oral and maxillofacial surgery. Surgeons are increasingly likely to be faced with a dilemma of either continuing antiplatelet therapy and risking serious haemorrhage or withholding therapy and risking fatal thromboembolic complications. While there are national recommendations for patients taking oral antiplatelet drugs undergoing invasive minor oral surgery, there are still no evidence-based guidelines for the management of these patients undergoing major oral and maxillofacial surgery. METHODS: MEDLINE and EMBASE databases were searched to retrieve all relevant articles published to 31 December 2017. FINDINGS: A brief outline of the commonly used antiplatelet agents including their pharmacology and therapeutic indications is discussed, together with the haemorrhagic and thromboembolic risks of continuing or altering the antiplatelet regimen in the perioperative period. Finally, a protocol for the management of oral and maxillofacial patients on antiplatelet agents is presented. CONCLUSIONS: Most current evidence to guide decision making is based upon non-randomised observational studies, which attempts to provide the safest possible management of patients on antiplatelet therapy. Large randomised clinical trials are lacking.


Assuntos
Anticoagulantes/administração & dosagem , Procedimentos Cirúrgicos Bucais/métodos , Inibidores da Agregação de Plaquetas/administração & dosagem , Administração Oral , Anticoagulantes/farmacologia , Tempo de Sangramento , Perda Sanguínea Cirúrgica/prevenção & controle , Substituição de Medicamentos , Quimioterapia Combinada , Humanos , Procedimentos Cirúrgicos Ortognáticos/métodos , Segurança do Paciente , Inibidores da Agregação de Plaquetas/farmacologia , Fatores de Risco , Tromboembolia/prevenção & controle
2.
Urology ; 135: 106-110, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31626857

RESUMO

OBJECTIVE: To examine long- and short-term outcomes using cell salvage with a commercially available leukocyte depletion filter following radical cystectomy in an oncologic population. MATERIALS AND METHODS: One hundred and fifty-seven patients, 87 of whom received a cell salvage transfusion, were retrospectively identified from chart review. Ninety-day outcomes as well as long-term mortality and cancer recurrence data were collected. Chi-square, Student's t, or Mann-Whitney U tests were used as appropriate. Multivariable regressions of survival were performed with a Cox proportional-hazards model. RESULTS: Those who received a cell salvage transfusion did not show any differences in rate of cancer recurrence (23%) vs those who did not receive a cell salvage transfusion (24%; P = .85). There were also no differences noted in mortality rates between the 2 populations (12% vs 17%; P = .36). Furthermore, no differences were noted in postoperative complication rates, length of hospital stay, 90-day culture positive infections or readmissions (P >.05). CONCLUSION: There are no significant differences in short-term or long-term patient outcomes between those who did and did not receive an intraoperative cell salvage transfusion. Cell salvage transfusions with a leukocyte depletion filter are safe and effective methods to reduce the need for allogeneic blood transfusions while controlling for the theoretical risk of metastatic spread.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue Autóloga/efeitos adversos , Cistectomia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Recuperação de Sangue Operatório/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue Autóloga/métodos , Feminino , Filtração/instrumentação , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Procedimentos de Redução de Leucócitos/instrumentação , Leucócitos/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Inoculação de Neoplasia , Recuperação de Sangue Operatório/instrumentação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
3.
Br J Anaesth ; 124(1): 35-43, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31607387

RESUMO

BACKGROUND: Bleeding and transfusions affect mortality in aortic surgery. Although tranexamic acid significantly reduced bleeding in multiple settings, its role in major vascular surgery was never studied. The aim of this study was to determine if tranexamic acid reduces blood loss in open abdominal aortic aneurysm (AAA) surgery. METHODS: A total of 100 patients undergoing elective open AAA repair were randomised to receive tranexamic acid (a loading dose of 500 mg and a continuous infusion of 250 mg h-1) or placebo. The primary outcome was intraoperative blood loss, and the secondary outcomes were the number of patients receiving red blood cells, occurrence of thromboembolic events, and mortality. Data were analysed using the intention-to-treat principle. RESULTS: Fifty patients were randomised into each group. Median (inter-quartile range) intraoperative blood loss was 400 (300-1050) ml in the tranexamic acid group vs 500 (360-1000) ml in the placebo group (P=0.44). Transfusion rate was seven/50 (14%) in the tranexamic group vs 12/50 (24%) in the placebo group (P=0.20). No thrombosis was recorded. In a post hoc analysis, postoperative blood loss was reduced in the tranexamic group both at 4 h (60 [40-80] ml vs 100 [60-140] ml, P<0.001) and 24 h (180 [120-275] vs 275 [190-395] ml, P=0.003) after surgery. At 1 yr, three patients were dead, all in the placebo group (P=0.24) and all after 28 days. CONCLUSIONS: Tranexamic acid did not reduce intraoperative blood loss or blood transfusions in open AAA repair, although it may reduce postoperative blood loss without increasing adverse effects. CLINICAL TRIAL REGISTRATION: NCT02335359.


Assuntos
Antifibrinolíticos/uso terapêutico , Aneurisma Aórtico/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/métodos , Ácido Tranexâmico/uso terapêutico , Idoso , Antifibrinolíticos/efeitos adversos , Aneurisma Aórtico/mortalidade , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Método Duplo-Cego , Transfusão de Eritrócitos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Ácido Tranexâmico/efeitos adversos
4.
Anaesthesia ; 75(3): 331-337, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31867715

RESUMO

Postpartum haemorrhage is a leading cause of maternal death during childbirth. There is an increasing incidence of atonic postpartum haemorrhage in developed countries, and maternal obesity has been proposed as a contributing factor. The dose-response relationship of carbetocin in obese women has not yet been determined. We conducted a double-blind, dose-finding study of carbetocin using a biased coin up-and-down design in women with a body mass index ≥ 40 kg.m-2 undergoing elective caesarean section. The determinant for a successful response was satisfactory uterine tone, with no intra-operative need for additional uterotonic drugs. Secondary outcomes included the use of additional uterotonic drugs postoperatively, estimated blood loss and adverse effects of carbetocin administration. Thirty women were recruited to the study. The median (IQR [range]) body mass index was 44.93 (41.5-55.2 [40-66.5]) kg.m-2 . The ED90 of carbetocin was estimated as 62.9 (95%CI 57.0-68.7) µg using the truncated Dixon and Mood method, and 68 (95%CI 52-77) µg using the isotonic regression method. The estimated blood loss was 880 (621-1178 [75-2442]) ml. The overall rates of hypotension and hypertension after delivery were 40% and 6.7%, respectively, while nausea occurred in 26.7% of women. The ED90 for carbetocin in obese women at elective caesarean section is lower than the dose of 100 µg currently recommended by the Society of Obstetricians and Gynaecologists of Canada, but is approximately four times higher than the previously demonstrated ED90 of 14.8 µg in women with body mass index < 40 kg.m-2 .


Assuntos
Cesárea/métodos , Obesidade/complicações , Ocitócicos/administração & dosagem , Ocitocina/análogos & derivados , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Índice de Massa Corporal , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Ocitocina/administração & dosagem , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Estudos Prospectivos , Resultado do Tratamento , Útero/efeitos dos fármacos
5.
Orthop Clin North Am ; 51(1): 7-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739881

RESUMO

Surgical techniques used to decrease the amount of blood lost during the procedure range from tourniquets to electrocautery and, more recently, the use of antifibrinolytics. Currently, tranexamic acid is the most commonly used antifibrinolytic in arthroplasty procedures. It was previously thought that intravenous tranexamic acid was more effective than topical tranexamic acid, but had an increased risk of thrombosis and cardiac events; however, this study showed that topical tranexamic acid is as effective in decreasing blood loss and the need for a blood transfusion after hybrid fixation total knee arthroplasty as with cemented total knee arthroplasty.


Assuntos
Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Torniquetes/efeitos adversos , Ácido Tranexâmico/administração & dosagem , Administração Tópica , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , Cimentação/tendências , Humanos , Período Pós-Operatório , Estudos Retrospectivos , Ácido Tranexâmico/uso terapêutico
6.
Ceska Gynekol ; 84(5): 337-340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826629

RESUMO

OBJECTIVE: To describe a case report with prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc; Department of Radiology, University Hospital, Olomouc; Department of Health Care Sciencies, Bata University, Zlín. CASE REPORT: We describe case report with prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient in attempt to decrease the risk of heavy peroperative bleeding. Twenty eight years old primigravida underwent prophylactic internal iliac artery balloon catheterization with interventional radiology preoperatively. Two 6-Fr balloon catheters transfemorally bilaterally up to internal iliac artery with position a “cross over“ were introduced, according to Seldingers standard technique. The procedure was without complications, estimated blood loss was 500 ml. CONCLUSION: Prophylactic placement of intravascular balloon catheters is a feasible treatment for Jehova´s Witnesses patients in efforts to decrease the risk of heavy bleeding during cesarean section.


Assuntos
Oclusão com Balão/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/métodos , Placenta Acreta/terapia , Cuidados Pré-Operatórios/métodos , Hemorragia Uterina/prevenção & controle , Adulto , Feminino , Humanos , Artéria Ilíaca , Gravidez , Útero/irrigação sanguínea , Útero/cirurgia
7.
Medicine (Baltimore) ; 98(44): e17767, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689838

RESUMO

The aim of this study was to evaluate the efficacy and safety of prophylactic intraoperative bilateral uterine or internal iliac artery embolization in planned cesarean for pernicious placenta previa in the third trimester of pregnancy.The patients with pernicious placenta previa were retrospectively included from January 2011 to May 2018, being divided into embolization group and control group. Intraoperative uterine artery embolization (UAE) or internal iliac artery embolization (IIAE) was undertaken to stop intrapartum and postpartum hemorrhage in embolization group.There were no significant differences on age, pregnancy times, gestational age, neonatal weight, neonatal asphyxia, prenatal bleeding, placental implantation, and mortality between embolization group and control group (P > .05). The amount of intraoperative and postoperative bleeding in embolization group was significantly greater than that in control group (P < .05). However, the hysterectomy rate in the embolization group was significantly lower than that in the control group (P < .05). Two (6.25%, 2/32) cases had undergone the second time embolotherapy after 8 hours of cesarean surgery because of severe vaginal bleeding. One case (3.13%, 1/32) died of diffuse intravascular coagulation because of hemorrhagic shock in embolization group. Transient and self-remitted lumbosacral pain was present in 28 (95%, 28/32) patients and no other severe interventional complications were reported in embolization group. All babies in 2 groups were healthy at half to 5 years' follow-up.The prophylactic intraoperative embolization of bilateral UAE or IIAE may be an effective strategy to treat intractable peripartum hemorrhage and preserve the fertility in patients with pernicious placenta previa.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/efeitos adversos , Cuidados Intraoperatórios/métodos , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Embolização da Artéria Uterina/métodos , Adulto , Feminino , Humanos , Artéria Ilíaca/cirurgia , Gravidez , Terceiro Trimestre da Gravidez , Procedimentos Cirúrgicos Profiláticos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Artéria Uterina/cirurgia
8.
Medicine (Baltimore) ; 98(45): e17816, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702635

RESUMO

Massive blood transfusion (MBT) increased mortality and morbidity after cardiac surgery. However, a mid-term follow-up study on repair surgery of acute type A aortic dissection (AAAD) with MBT was lacking. This study aimed to assess the impact of perioperative MBT on late outcomes of surgical repair for AAAD.There were 3209 adult patients firstly received repair surgery for AAAD between 2005 and 2013, were identified using Taiwan National Health Insurance Research Database. Primary interest variable was MBT, defined as transfused red blood cell (RBC) ≥10 units.The outcomes contained in-hospital mortality, surgical-related complications, all-cause mortality, respiratory failure, and chronic kidney disease (CKD) during follow-up period. Higher in-hospital mortality (37.7% vs 11.6%; odds ratio, 4.00; 95% confidence interval [CI], 3.30-4.85), all-cause mortality (26.1% vs 13.0%; hazard ratio [HR], 1.66; 95% CI, 1.36-2.04), and perioperative complications were noted in the MBT group. A subdistribution hazard model revealed higher cumulative incidence of CKD (13.9% vs 6.5%; HR, 1.95; 95% CI, 1.47-2.60) and respiratory failure (7.1% vs 2.7%; HR, 2.34; 95% CI, 1.52-3.61) for the MBT cohort. A dose-dependent relationship between amount of transfused RBC (classified as tertiles) and cumulative incidence of all-cause mortality, incident CKD, and respiratory failure was found (P of trend test <.001).Patients with MBT had worse late outcomes following surgical repair of AAAD. The cumulative incidence of all-cause mortality, incident CKD, and respiratory failure increased with the amount of transfused RBC in a dose-dependent manner.


Assuntos
Aneurisma Dissecante/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/mortalidade , Perda Sanguínea Cirúrgica/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan , Resultado do Tratamento , Adulto Jovem
9.
Medicine (Baltimore) ; 98(38): e17263, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568002

RESUMO

To discuss the feasibility, safety, and effectiveness of off-clamp robotic partial nephrectomy via retroperitoneal approach and provide data for evidence based medicine in the surgical treatment of renal tumor.The clinical data was documented and compared between robotic retroperitoneal partial nephrectomy with and without hilar occlusion (clamp group and off-clamp group) performed between January 1, 2015 and December 31, 2017.Six-months post-operative renal function was superior in the off-clamp group compared with clamp group, while long-term results remained to be elucidated. No significant difference in post-operative hospital stay was found between the 2 groups. Estimated blood loss in off-clamp group was significantly higher than clamp group, while no significant difference was found in transfusion rate.Off-clamp robotic partial nephrectomy via retroperitoneal approach is a safe and effective technique for the removal of renal tumor while the indication of surgery is strictly limited to small (<4 cm) and exophytic renal tumor.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Laparoscopia , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(37): e16936, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517814

RESUMO

The study aimed to investigate the effect of ratios of marrow cavity diameter to intramedullary nail diameter from different layers on hidden blood loss (HBL), overt blood loss (OBL) and total blood loss (TBL) during using proximal femoral nail antirotation-Asian version (PFNA)-II for femoral intertrochanteric fractures.We retrospectively studied 70 patients treated in our hospital recently. We recorded postoperative hematocrit (Hct) and OBL during operation. TBL and HBL were calculated using CROSS equation. The ratios of marrow cavity diameter to intramedullary nail diameter from different layers, including start of funnel, end of funnel and femoral isthmus, were measured. The mean of the ratio from frontal and lateral X-ray were designated as R. We classified all included participants into a high and a low matching group according to z-score of R within each layer. TBL, HBL, and OBL were compared between the 2 groups. We applied multiple linear regression analysis between the HBL as a dependent variable and gender, age, body mass index, fracture type, and R as independent variables.The present study indicated a significant reduction in the HBL and TBL in the high matching group compared to low matching group on three layers, whereas it showed no significant difference in OBL between the 2 groups on three layers. It showed that R values from start of funnel and end of funnel were significantly associated with HBL.Matching rate of PFNA II at the funnel might be an important factor for HBL and TBL postoperatively.


Assuntos
Perda Sanguínea Cirúrgica , Medula Óssea/diagnóstico por imagem , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/prevenção & controle , Medula Óssea/patologia , Feminino , Fraturas do Fêmur/patologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Hemorragia Pós-Operatória/patologia , Hemorragia Pós-Operatória/terapia , Estudos Retrospectivos
12.
Scand Cardiovasc J ; 53(6): 355-360, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476919

RESUMO

Objectives: Protamine reduces platelet aggregation after cardiopulmonary bypass (CPB). We studied the inhibitory effect of a reduced protamine dose, the duration of impaired platelet function and the possible correlation to postoperative bleeding. Design: Platelet function was assessed by impedance aggregometry in 30 patients undergoing cardiac surgery with CPB at baseline, before protamine administration, after 70% and 100% of the calculated protamine dose, after 20 minutes and at arrival to the intensive care unit. Adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used as activators. Blood loss was measured during operation and three hours after surgery. Results are presented as median (25th-75th percentile). Results: Platelet aggregation decreased markedly after the initial dose of protamine (70%) with all activators; ADP 89 (71-110) to 54 (35-78), TRAP 143 (116-167) to 109 (77-136), both p < .01; AA 25 (16-49) to 17 (12-24) and COL 92 (47-103) to 60 (38-81) U, both p < .05. No further decrease was seen after 100% protamine. The effect was transient and after twenty minutes platelet aggregation had started to recover; ADP 76 (54-106), TRAP 138 (95-158), AA 20 (10-35), COL 70 (51-93) U. Blood loss during operation correlated to aggregometry measured at baseline and after protaminization. Conclusions: Protamine after CPB induces a marked decrease in platelet aggregation already at a protamine-heparin ratio of 0.7:1. The impairment seems to be transient and recovery had started after 20 minutes.


Assuntos
Ponte de Artéria Coronária , Implante de Prótese de Valva Cardíaca , Antagonistas de Heparina/efeitos adversos , Agregação Plaquetária/efeitos dos fármacos , Protaminas/efeitos adversos , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Ponte Cardiopulmonar , Ponte de Artéria Coronária/efeitos adversos , Relação Dose-Resposta a Droga , Transfusão de Eritrócitos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Antagonistas de Heparina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Plaquetária , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Protaminas/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
13.
Bone Joint J ; 101-B(9): 1093-1099, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474134

RESUMO

AIMS: Antifibrinolytic agents, including tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have been shown to be safe and effective for decreasing perioperative blood loss and transfusion following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there are few prospective studies that directly compare these agents. The purpose of this study was to compare the benefits of intraoperative intravenous TXA with EACA. PATIENTS AND METHODS: A total of 235 patients (90 THA and 145 TKA) were enrolled in this prospective, randomized controlled trial at a single tertiary-care referral centre. In the THA cohort, 53.3% of the patients were female with a median age of 59.8 years (interquartile range (IQR) 53.3 to 68.1). In the TKA cohort, 63.4% of the patients were female with a median age of 65.1 years (IQR 59.4 to 69.5). Patients received either TXA (n = 119) or EACA (n = 116) in two doses intraoperatively. The primary outcome measures included change in haemoglobin level and blood volume, postoperative drainage, and rate of transfusion. Secondary outcome measures included postoperative complications, cost, and length of stay (LOS). RESULTS: TKA patients who received EACA had greater drainage (median 320 ml (IQR 185 to 420) vs 158 ml (IQR 110 to 238); p < 0.001), increased loss of blood volume (891 ml (IQR 612 to 1203) vs 661 ml (IQR 514 to 980); p = 0.014), and increased haemoglobin change from the preoperative level (2.1 ml (IQR 1.7 to 2.8) vs 1.9 ml (IQR 1.2 to 2.4); p = 0.016) compared with patients who received TXA. For the THA cohort, no statistically significant differences were observed in any haematological outcome measure. One patient in the EACA group required transfusion. No patient in the TXA group required transfusion. There were no statistically significant differences in number or type of postoperative complications or LOS for either THA or TKA patients regardless of whether they received TXA or EACA. CONCLUSION: For hip and knee arthroplasty procedures, EACA is associated with increased perioperative blood loss compared with TXA. However, there is no significant difference in transfusion rate. While further prospective studies are needed to compare the efficacy of each agent, we currently recommend orthopaedic surgeons to select their antifibrinolytic based on cost and regional availability. Cite this article: Bone Joint J 2019;101-B:1093-1099.


Assuntos
Ácido Aminocaproico/administração & dosagem , Antifibrinolíticos/administração & dosagem , Artroplastia de Substituição/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Administração Intravenosa , Idoso , Ácido Aminocaproico/uso terapêutico , Antifibrinolíticos/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Transfusão de Sangue , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Estudos Prospectivos , Ácido Tranexâmico/uso terapêutico
14.
Medicine (Baltimore) ; 98(34): e15852, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441836

RESUMO

BACKGROUND: The purpose of this study was to investigate the benefits and harm of combined administration of tranexamic acid (TXA) and dexamethasone (Dexa) in total knee arthroplasty (TKA). METHODS: A total of 88 consecutive patients undergoing TKA for knee osteoarthritis were stratified in 2 groups. All surgeries were performed under general anesthesia. Brief, patients in the TXA + Dexa group (n = 45) received 10 mg Dexa just after the anesthesia, and repeated at 24 hours after the surgery; and patients in the TXA group (n = 43) received 2 ml of normal saline solution at the same time. The measured outcomes were the C-reactive protein (CRP) and interleukin-6 (IL-6) from preoperatively to postoperatively, and postoperative nausea and vomiting (PONV), fatigue, range of motion (ROM), length of stay (LOS), and the analgesic and antiemetic rescue consumption RESULTS:: The level of CRP and IL-6 in the TXA + Dexa group were lower than that in the TXA group at 24 hours (P < .001, P < .001), 48 hours (P < .001, P < .001), and 72 hours (P < .001, P < .001) after the surgery. The pain scores in the TXA + Dexa group were lower during walking at 24 hours (P < .001), 48 hours (P < .001), and 72 hours (P < .001) and at rest at 24 hours (P = .022) after the surgery. Patients in the TXA + Dexa group had a lower nausea score, the incidence of PONV, fatigue, and the analgesic and antiemetic rescue consumption, and had a greater ROM than that in the TXA group. No significant differences were found in LOS and complications. CONCLUSION: The combined administration of TXA + Dexa significantly reduced the level of postoperative CRP and IL-6, relieve postoperative pain, ameliorate the incidence of POVN, provide additional analgesic and antiemetic effects, reduce postoperative fatigue, and improve ROM, without increasing the risk of complications in primary TKA.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/métodos , Dexametasona/uso terapêutico , Ácido Tranexâmico/uso terapêutico , Idoso , Analgésicos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Antieméticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Proteína C-Reativa/efeitos dos fármacos , Dexametasona/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Mediadores da Inflamação/metabolismo , Interleucina-6/biossíntese , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Náusea e Vômito Pós-Operatórios/prevenção & controle , Amplitude de Movimento Articular , Ácido Tranexâmico/administração & dosagem
15.
World Neurosurg ; 131: e570-e578, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400524

RESUMO

OBJECTIVE: Spine surgeons increasingly encounter acute spinal pathologies in patients treated with direct oral anticoagulants (DOACs), but only limited data on the management of these patients are currently available. METHODS: We retrospectively analyzed patients who presented to our department with acute spinal pathology during treatment with DOAC and who required urgent surgical therapy. Patient characteristics and treatment modalities were studied, with specific focus on the management of hemostasis and surgical therapy. Furthermore, we analyzed 19 cases of spinal emergencies during DOAC treatment reported in the literature. RESULTS: A total of 12 patients were identified and included in the present analysis. Patients suffered from acute spinal cord compression caused by spinal tumor manifestation (n = 5), empyema (n = 4), degenerative spinal stenosis (n = 1), hematoma (n = 1), and vertebral body fracture/dislocation (n = 2). All patients underwent emergency surgical treatment. Prohemostatic substances were administered perioperatively in 10 patients (83%) and included administration of prothrombin complex concentrates (83%), tranexamic acid (17%), and transfusion of platelets (8%). A total of 9 patients (75%) showed postoperative improvement of neurologic symptoms, and the in-hospital mortality in this patient cohort was 17%. CONCLUSIONS: Emergency spine surgery is feasible and should be considered in patients on treatment with DOAC. The (low) risk of intraoperative bleeding complications has to be weighed against the risk of permanent disability if surgical decompression is delayed. Administration of prothrombin complex concentrates and tranexamic acid may improve the coagulation before surgery, especially in cases of unavailable specific antidotes.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Descompressão Cirúrgica/métodos , Emergências , Inibidores do Fator Xa/efeitos adversos , Hemostáticos/uso terapêutico , Compressão da Medula Espinal/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Antitrombinas/efeitos adversos , Fatores de Coagulação Sanguínea/uso terapêutico , Feminino , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Perimeníngeas/complicações , Infecções Perimeníngeas/cirurgia , Transfusão de Plaquetas , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Ácido Tranexâmico/uso terapêutico
16.
Medicine (Baltimore) ; 98(35): e16963, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464938

RESUMO

We investigated the clinical application of auricular point sticking (APS) combined with tranexamic acid in perioperative hemostasis in elderly patients with intertrochanteric fractures of the femur.This is a prospective cohort study, and we analyzed 86 elderly patients with intertrochanteric fractures of the femur who underwent closed reduction and internal fixation with proximal femoral nail antirotation (PFNA) between January 2016 and December 2016. The patients were divided into auricular point combined with tranexamic acid group (APS group, n = 43) and tranexamic acid alone group (Control group, n = 43). APS was performed for patients using Vaccaria seeds 1 to 2 days before the operation. The 4 acupoints of hemostasis, including spleen, diaphragm, pituitary, and adrenal gland, as well as acupoint of hip joint, were selected. Routine treatment was performed using tranexamic acid alone in the control group. Blood transfusion, intraoperative, postoperative, and total blood loss were compared between the 2 groups.This study enrolled 36 males and 50 females aged 71 to 93 years (average age: 78.5 years). There were no significant differences in gender, age, height, weight, preoperative hematocrit level, fracture classification, operative time, and hospitalization stay (P > .05). Total blood loss was lower in the APS group than the control group (244.26, 197.87-258.50 ml vs 533.94, 424.00-598.09 ml, P < .01). The blood transfusion rate was 14.0% in the APS group and 34.9% in the control group (P = .02).APS can reduce perioperative bleeding and decrease the need for blood transfusion in elderly patients with intertrochanteric fractures of the femur. This noninvasive method can be applied clinically. Randomized trials may be needed to confirm the findings.


Assuntos
Terapia por Acupuntura/métodos , Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Fraturas do Quadril/cirurgia , Ácido Tranexâmico/administração & dosagem , Pontos de Acupuntura , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Feminino , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Estudos Prospectivos
17.
Eur Arch Otorhinolaryngol ; 276(11): 3095-3104, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31363901

RESUMO

PURPOSE: Intense bleeding of the surgical field is a potential factor influencing success of functional endoscopic sinus surgery (FESS). Hypotensive anesthesia with α2 intravenous agonists reduces intraoperative bleeding, but which is the best agent is unknown. The main objective of this trial was to compare the current standard adjuvant drug for hypotensive anesthesia, clonidine, with the recently available alternative dexmedetomidine. METHODS: A randomized clinical trial compared the efficacy of clonidine and dexmedetomidine during FESS. Treatment was open label for the anesthesiologist and operating surgeon, but blind for an external evaluator who evaluated video-recorded surgeries. A Boezaart scale was assessed every 30 min during FESS until surgery completion. Main end-point was the proportion of patients with mean Boezaart scores > 2 (heavy bleeding) by external blinded evaluator. Secondary end-points included other bleeding parameters, surgery duration, hemodynamic measures and surgical complications. RESULTS: 94 patients were randomized. There were no significant differences in the proportion of patients with mean Boezaart scores > 2 in clonidine (42.6%) and dexmedetomidine (42.6%). Consistently, no differences were observed in secondary variables of bleeding, duration or complications. Small differences in mean heart rate were observed that might reflect different pharmacological profiles of the products, but are of uncertain clinical relevance. CONCLUSIONS: No significant differences were observed between clonidine and dexmedetomidine when used as anesthetic adjuvants in the reduction of surgical bleeding in FESS. A longer experience with clonidine and its lower costs suggest it may be a preferable option as an adjuvant for hypotensive anesthesia.


Assuntos
Anestesia/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Clonidina , Dexmedetomidina , Endoscopia , Seios Paranasais/cirurgia , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Doença Crônica , Clonidina/administração & dosagem , Clonidina/efeitos adversos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/cirurgia , Duração da Cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(28): e16115, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305395

RESUMO

INTRODUCTION: The benefits of magnesium sulfate for surgical field during endoscopic sinus surgery remain controversial. We conduct a systematic review and meta-analysis to explore the influence of magnesium sulfate versus placebo on surgical field during endoscopic sinus surgery. METHODS: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2018 for randomized controlled trials (RCTs) assessing the effect of magnesium sulfate versus placebo on surgical field during endoscopic sinus surgery. This meta-analysis is performed using the random-effect model. RESULTS: Four RCTs and 404 patients are included in the meta-analysis. Overall, compared with control group endoscopic sinus surgery, magnesium sulfate has remarkably positive impact on surgical field scores (MD = -1.76; 95% CI = -2.33 to -1.18; P < .00001), and intraoperative blood loss (MD = -89.09; 95% CI = -163.20 to -14.97; P = .02), but shows no markedly effect on surgery duration (MD = -7.08; 95% CI = -21.38 to 7.22; P = .33), fentanyl (MD = -0.64; 95% CI = -1.97 to 0.70; P = .35), and vecuronium (MD = -3.64; 95% CI = -10.99 to 3.70; P = .33). CONCLUSIONS: Magnesium sulfate exerts positive impact on surgical field and blood loss reduction for endoscopic sinus surgery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Sulfato de Magnésio/uso terapêutico , Cirurgia Endoscópica por Orifício Natural , Vasodilatadores/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Br J Radiol ; 92(1102): 20190127, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31317769

RESUMO

OBJECTIVE: We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section. METHODS: We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups. RESULTS: 20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time (p < 0.001), hysterectomy (p < 0.001), post-operative hospital stay (p < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, p < 0.01]. CONCLUSION: The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section. ADVANCES IN KNOWLEDGE: Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.


Assuntos
Oclusão com Balão , Cesárea/métodos , Circulação Colateral , Artéria Ilíaca , Ovário/irrigação sanguínea , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Operatória/etiologia , Adulto , Angiografia , Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Artérias/diagnóstico por imagem , Oclusão com Balão/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Histerectomia , Artéria Ilíaca/diagnóstico por imagem , Placenta Acreta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Hemorragia Pós-Operatória/prevenção & controle , Gravidez , Estudos Retrospectivos , Fatores de Risco , Ligamento Redondo do Útero/irrigação sanguínea , Ultrassonografia , Útero/irrigação sanguínea
20.
J Orthop Traumatol ; 20(1): 28, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31321578

RESUMO

INTRODUCTION: Total knee arthroplasty (TKA) surgery can be associated with significant blood loss. Among the problems associated with such blood loss is the need for transfusions of banked blood [1]. Transfusions not only have a financial consequence but also carry a small risk of disease transmission to the patient. Antifibrinolytics have been successfully used to reduce transfusion requirements in elective arthroplasty patients. The objective of this meta-analysis is to determine which of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) is more effective for reducing peri-operative blood loss, and lessening the need for blood transfusion following knee arthroplasty surgery. MATERIALS AND METHODS: MEDLINE, Embase and CINAHL databases were searched for relevant articles published between January 1980 to January 2018 for the purpose of identifying studies comparing TXA and EACA for TKA surgery. A double-extraction technique was used, and included studies were assessed regarding their methodological quality prior to analysis. Outcomes analysed included blood loss, pre- and post-operative haemoglobin, number of patients requiring transfusion, number of units transfused, operative and tourniquet time, and complications associated with antifibrinolytics. RESULTS: Three studies contributed to the quantitative analysis of 1691 patients, with 743 patients included in the TXA group and 948 in the EACA group. Estimated blood loss was similar between the two groups [95% confidence interval (CI) -0.50, 0.04; Z = 1.69; P = 0.09]. There were no differences between the two groups regarding the percentage of patients requiring transfusion (95% CI 0.14, 4.13; Z = 0.31; P = 0.76). There was no difference in the pre- and post-operative haemoglobin difference between the two groups (95% CI -0.36, 0.24; Z = 0.38; P = 0.70). There was no difference in the average number of transfused units (95% CI -0.53, 0.25; Z = 0.71; P = 0.48). There was no difference in the operative (95% CI -0.35, 0.36; Z = 0.04; P = 0.97) or tourniquet time (95% CI -0.16, 0.34; Z = 0.72; P = 0.47). Similarly, there was no difference in the percentage of venous thromboembolism between the two groups (95% CI 0.17, 2.80; Z = 0.51; P = 0.61). CONCLUSIONS: This study did not demonstrate TXA to be superior to EACA. In fact, both antifibrinolytic therapies demonstrated similar efficacy in terms of intra-operative blood loss, transfusion requirements and complication rates. Currently EACA has a lower cost, which makes it an appealing alternative to TXA for TKA surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Ácido Aminocaproico/uso terapêutico , Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Antifibrinolíticos/efeitos adversos , Transfusão de Sangue , Feminino , Humanos , Masculino , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Tromboembolia Venosa/etiologia
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