Effect of the menstrual cycle on intraoperative bleeding in rhinoplasty patients

Is menstruation a valid reason to postpone cardiac surgery?

Background:

Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss.

Aims:

The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation.

Settings and Design:

A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS.

Patients and Methods:

The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss.

Results:

The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10).

Conclusion:

Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

Photobiomodulation of acute pain syndrome after septoplasty

The paper evaluates the effectiveness of the use of therapeutic laser exposure (photobiomodulation therapy – PBMT) to minimize acute pain in the early postoperative period in patients after septoplasty. The study included two groups of patients. Patients of the first group (31 patients) underwent septoplasty with standard management in the postoperative period. Patients of the second group (31 patients) also underwent septoplasty, and then added PBMT to the standard measures of the postoperative period at 3, 6 and 24 h after septoplasty (λ = 0.890 μm, P = 10 W, 2 min) and then intranasally 48 h after septoplasty (λ = 0.630 μm, P = 8 W, 2 min). In patients of both groups, heart rate variability and pain were assessed using a visual analog scale within 48 hours after septoplasty. In patients of the second group, after the use of PBMT, the indicators of heart rate variability had a significantly lower total power, compared with patients of the first group. So, after PBMT, the ultra-low-frequency component of the spectral analysis of heart rate variability in the first group was 18580 ± 2067 ms2, which is significantly higher than in the second group (8086 ± 3003 ms2) (p <0.001). The low-frequency component of heart rate variability was also significantly higher in the first group (1871 ± 405 ms2) compared to the second (1095 ± 190 ms2) (p <0.005), which indicates an increase in the tension of the sympathetic part of the autonomic nervous system in the group without the use of PBMT. In the first 3 hours after surgery, the severity of pain between the groups did not differ significantly (p = 0.07). In the period from 6 to 24 hours after surgery, patients who did not undergo PBMT experienced significantly higher pain than patients with PBMT (p <0.001). Thus, in our study, the group of patients with PBMT showed better results in pain and heart rate variability compared to the classical rehabilitation of patients after septoplasty.

Optimal timing of the loop electrosurgical excision procedure according to different phases of the menstrual cycle

OBJECTIVE

To determine whether treatment of cervical precancerous lesions in the follicular phase or luteal phase of the menstrual cycle affects perioperative and postoperative blood loss during the LEEP.

METHODS

In this randomized trial, 73 patients were assigned to either the follicular phase group (n = 37) or the luteal phase group (n = 36). Ultimately, the conditions of 36 patients in the follicular phase group and 34 patients in the luteal phase group were analyzed. The primary outcome measure was median early postoperative blood loss. Secondary outcomes were median intraoperative bleeding, the rate of late postoperative bleeding, and persistent vaginal bleeding.

RESULTS

Baseline demographic data were similar in the two groups. Median intraoperative blood loss was significantly lower in the follicular phase group than in the luteal phase group (32.7 [20.1-78.3] vs. 44.6 [30.4-104.2] mL, respectively; P < 0.001). Median early postoperative blood loss was also lower in the follicular phase group than in the luteal phase group (209.2 [67.7-468.6] vs. 289.0 [120.3-552.8] mL, respectively; P = 0.01). Moreover, the rate of late postoperative bleeding was higher in the luteal phase group than in the follicular phase group (20.6% vs. 2.8%, respectively; P = 0.02).

CONCLUSION

Performing LEEP during the follicular phase of the menstrual cycle significantly reduces median intraoperative blood loss, early postoperative blood loss, and the rate of late postoperative blood loss.

Does Menses Affect the Risk of Blood Loss in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion Surgeries?: A Propensity-Score Matching Study

STUDY DESIGN

Retrospective propensity score matching study.

OBJECTIVE

To investigate whether menses affect intraoperative blood loss in female adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) surgeries.

SUMMARY OF BACKGROUND DATA

There were concerns whether patients having menses will have higher intraoperative blood loss if surgery were to be done during this period.

METHODS

This study included 372 females who were operated between May 2016 to May 2019. Fifty-five patients had menses during surgery (Group 1, G1) and 317 patients did not have menses during surgery (Group 2, G2). Propensity score matching (PSM) analysis with one-to-one, nearest neighbor matching technique and with a match tolerance of 0.001 was used. The main outcome measures were intraoperative blood loss (IBL), volume of blood salvaged, transfusion rate, preoperative hemoglobin, preoperative platelet, preoperative prothrombin time, preoperative activated partial thromboplastin time (APTT), international normalized ratio (INR), and postoperative hemoglobin. Postoperative Cobb angle and correction rate were also documented.

RESULTS

At the end of PSM analysis, 46 patients from each group were matched and balanced. The average operation duration for G1 was 140.8 ± 43.0 minutes compared with 143.1 ± 48.3 minutes in G2 (P = 0.806). The intraoperative blood loss for G1 was 904.3 ± 496.3 mL and for G2 was 907.9 ± 482.8 mL (P = 0.972). There was no significant difference in terms of normalized blood loss (NBL), volume of blood salvaged during surgery, preoperative hemoglobin, postoperative hemoglobin, hemoglobin drift, estimated blood volume (EBV), IBL per EBV and IBL per level fused (P > 0.05). No postoperative complications were encountered in both groups. On average, the postoperative hospital stay was 3.5 ± 0.8 days for both groups (P = 0.143).

CONCLUSION

Performing corrective surgery during the menstrual phase in female AIS patients is safe without risk of increased blood loss.

LEVEL OF EVIDENCE

4.

Does the phase of the menstrual cycle really matter to anaesthesia?

The menstrual cycle is a physiological phenomenon that is accompanied by several hormonal fluctuations involving oestrogen and progesterone. Oestrogen and progesterone exert several physiological effects. There are many questions pertaining to the influence of the physiology of menstruation on anaesthesia. We attempted to find out whether the phase of the menstrual cycle can alter the physiological functions during anaesthesia, the perioperative management and outcomes. We performed a literature search in Google Scholar, PubMed and Cochrane databases for original and reviewed articles on the phases of the menstrual cycle and their relation to anaesthesia-related physiological parameters to find an answer to these questions. Many studies have shown that women, perimenstrually, may have increased pain perception, exacerbation of systemic diseases, vocal cord/peripheral oedema and post-operative nausea and vomiting (PONV). Some of the other notable findings in most studies were sleep disturbances in the luteal phase (LP), increased occurrence of PONV in the ovulatory phase and a lower requirement of intravenous sedative and anaesthetic drug requirements in the LP. We found contradictory results concerning pain perception and PONV in relation to the follicular and LPs. However, we found that literature regarding the phase of the menstrual cycle and the haemodynamic response to intubation, anaesthesia-induced hypnosis and perioperative blood loss is relatively scarce. Thus, there is a need to conduct good quality research on these topics.

The menstrual cycle and blood loss during laparoscopic myomectomy

INTRODUCTION

Operative morbidity of laparoscopic myomectomy largely relates to the potential for intraoperative blood loss. We sought to determine whether blood loss varies according to the menstrual cycle.

MATERIAL AND METHODS

A retrospective study of 268 women who underwent a laparoscopic myomectomy from 2007 to 2012. Patients were categorized into five menstrual groups: follicular phase, luteal phase, oligomenorrheic or amenorrheic on hormonal therapy, postmenopausal or other. Patient and procedure characteristics were compared for the follicular phase group, luteal phase group, and hormonal therapy group. The estimated blood loss was compared across the five groups using a regression model.

RESULTS

A total of 268 women underwent a laparoscopic myomectomy: 108 (40.3%) were in the follicular phase, 92 (34.3%) were in the luteal phase, 44 (16.4%) were on hormonal therapy, nine (3.4%) were postmenopausal, and 15 (5.6%) could not be classified. Baseline patient characteristics were similar between the groups with the exception of endometriosis. Geometric mean estimated blood loss was 91.9 mL in the follicular phase group, 108.7 mL in the luteal phase group, 114.1 mL in the hormonal therapy group, and 39.8 mL in the postmenopausal group. There was no significant difference in the geometric mean estimated blood loss when comparing the follilcuar phase, luteal phase, and hormonal phase groups (p = 0.41). Upon adjusted multivariable analysis of all five menstrual groups, there was also no difference in estimated blood loss.

CONCLUSIONS

Intraoperative blood loss during laparoscopic myomectomy does not vary significantly with the phase of the menstrual cycle.

The Impact of the Menstrual Cycle on Perioperative Bleeding in Vitreoretinal Surgery

Purpose. To investigate the effect of menstrual cycle on perioperative bleeding of primary vitreoretinal surgery. Methods. Data on female patients who had vitrectomy surgery was retrospectively collected. Exclusion criteria were history of trauma, vitreous hemorrhage, previous vitreoretinal surgery, diabetic retinopathy, endophthalmitis, acute retinal necrosis, single vitreous opacity, and use of antiplatelet agents. Perioperative bleeding was defined as hemorrhage in the iris, vitreous, choroidal, retina, or subretina during surgery or up to one day postoperatively. 69 patients had surgery during the perimenstrual phase (group M, days 1–7 and days 21–28) and 86 during periovulatory phase (group O, days 8–20) were enrolled. Results. The proportion of operative bleeding in group M (14.5%) and group O (10.5%) was not found to be significantly different (p = 0.45). No postoperative bleeding was recorded in both groups. The univariate odds ratio (OR) and 95% confidence interval (CI) of perimenstrual phase for operative bleeding were 0.69 (0.26–1.81). After adjusting for patients' age, vitreoretinal diseases, and surgeons, the multivariate OR and 95% CI were 0.71 (0.27–1.86). Conclusion. This study suggests that the timing of the menstrual period does not affect perioperative bleeding for primary vitreoretinal surgery. Menstruation appears not to be a contraindication for vitreoretinal surgery.

Impact of different antithrombotics on the microcirculation and viability of perforator-based ischaemic skin flaps in a small animal model

The effects of antithrombotic drugs on random and free flap survival have been investigated in the past, but the experimental and clinical results are not in agreement. A perforator-based critical ischaemia model was used to evaluate the effects of different perioperatively administered pharmaceutical agents on tissue ischaemia and to assess the potential additional haemorheological or vasodilative effects of antithrombotics on flap microcirculation. Combined laser Doppler flowmetry and remission spectroscopy revealed an increase in certain microcirculation parameters in most groups in comparison with saline controls, and these changes correlated with flap survival. Clopidogrel and hirudin significantly improved the amount of viable flap tissue in comparison with controls, while unfractioned heparin had a negative effect on flap survival. Low molecular weight heparin, aspirin, pentoxifylline, and hydroxyethyl starch had no impact on the amount of viable flap tissue. A higher complication rate was observed in all experimental groups, but only clopidogrel had a negative impact on the flap viability. Our results add to the body of evidence supporting the conclusion that perioperative antithrombotic treatment improves flap survival. Clopidogrel and hirudin are effective pharmacological agents that significantly increased the viability of perforator-based skin flaps in rats, but at a higher risk of postoperative bleeding.

The Effect of Patient Positioning on Amount of Intraoperative Bleeding in Rhinoplasty: A Randomized Controlled Trial

BACKGROUND

There is a rich blood flow to the mucosa in the nasal region. In rhinoplasty, surgical procedures are performed in a narrow and confined space. So bleeding during surgery reduces visibility which can complicate the procedure. This study investigated the effects of the patient position on amount of intraoperative bleeding during surgical procedures.

PATIENTS AND METHODS

This randomized controlled trial was conducted on 71 patients who underwent elective rhinoplasty. The patients were operated on in three groups. Group 1 consisted of 23 patients who were operated on in the supine position; Group 2 included 28 patients who were operated on using a 15° angle reverse Trendelenburg position; Group 3 consisted of 20 patients who were operated on at a 20° angle reverse Trendelenburg position.

RESULTS

There were statistically significant differences between the groups in regard to surgeon satisfaction and the amount of intraoperative bleeding. The amount of intraoperative bleeding in Group 1 was significantly higher than those of Groups 2 and 3, and surgeon satisfaction was lower.

CONCLUSIONS

Reverse Trendelenburg position reduces intraoperative bleeding in rhinoplasty patients while facilitating the procedure compared to the supine position. Surgery at a 15° angle reverse Trendelenburg position provides the optimum working conditions by both significantly reducing intraoperative bleeding and allowing for comfortable conditions for the surgeon.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .