Assessment of Intraoperative Blood Loss during Oral and Maxillofacial Surgical Procedures in a Nigerian Tertiary Health Care Center

Is Blood Transfusion Justified During Soft Tissue Surgery in Noma Patients? A One-Year Appraisal at Noma Children Hospital, Sokoto, Nigeria

BACKGROUND

Non-utilization of blood and inappropriate blood transfusion are common in surgical operations. Some surgical procedures are associated with minimal bleeding that does not warrant blood transfusion. No previous study has looked at the pattern of blood loss in noma defect repair to determine the possible need for blood transfusion.

AIM/OBJECTIVES

This study aimed to determine the total amount of blood loss, the number of units of blood transfused, and the correlation between estimated blood loss and total operating time in patients who had surgical correction of noma defects.

MATERIALS AND METHODS

This is a hospital-based cross-sectional study of 35 patients who underwent surgical correction of noma defects. Age, sex, pre- and post-operative haemoglobin (Hb), number of requested blood units, total operating time, and total estimated blood loss were recorded. The methods used for the blood loss estimation were gauze swabs, Abdo-packs, drapes, and suction bottles.

RESULTS

Comparison of the mean pre- and post-operative Hb did not yield any statistically significant difference. The total estimated blood loss in these surgeries was in the range of 65-209 mL, with a mean of 117.20 ± 35.88 mL. No correlation between estimated blood loss and total operating time was noted (P = 0.940). No blood was transfused in any of the subjects.

CONCLUSION

This study observed minimal blood loss in surgical corrections of the soft tissue noma defect. Apart from blood grouping, there may be no need for routine cross-matching of blood pre-operatively for surgical repair of noma defect. However, more studies are needed to buttress this finding.

Intraoperative Blood Loss in Maxillofacial Trauma Surgery

Background and Objectives

This study is aimed to assess the intraoperative blood loss of patients with maxillofacial bone fracture surgical intervention and to assess their need for blood transfusion.

Materials and Methods

In this retrospective study, intraoperative blood loss of 206 patients with facial bone fractures, who underwent surgery between 2017 and 2018, was retrieved. The patient's demographic information, the amount of blood loss, the type of facial bone fracture, and the patient's requirement for blood products were evaluated.

Results

The average amount of intraoperative blood loss was 77.6 ml, and none of the patients required a blood transfusion during the operation in this group of patients. maxillofacial bone fracture was most common in young males. The leading cause of fractures was motor vehicle accident. There was a reverse correlation between the patient's age and surgical blood loss, but there was no statistically significant relationship between the patient's gender and intraoperative surgical blood loss.

Conclusion

The results of the present study show that preparation for blood transfusion in patients with maxillofacial traumatic bone fracture requiring surgery is uncommon if patients have no systemic disease or specific blood dyscrasias preoperatively.

AN AUDIT OF ORAL AND MAXILLOFACIAL PROCEDURES UNDER GENERAL ANAESTHESIA AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN, NIGERIA

BACKGROUND

Operating theatre time management is a constant source of tension among the healthcare professionals responsible for the use of the facility. It is important that all effort should be geared at optimal utilization of available resources and minimization of waste.

AIM

To appraise time management, frequency and duration of surgical procedures, frequency and determinants of blood transfusion in oral and maxillofacial surgery.

DESIGN OF THE STUDY

Prospective clinical study.

SETTING

The University College Hospital, Ibadan. Nigeria.

METHODOLOGY

This was a cross-sectional study of consecutive patients who had maxillofacial surgical procedures. Information was collected on number of cases scheduled per list, number of cases done per list, each patient's biodata, time intervals between patient arrival and departure from operating theatre, route and duration of intubation, type of surgical procedure, surgical time, preoperative and postoperative packed cell volume estimations, volume of blood loss and the frequency and volume of blood transfusions.

RESULTS

The main points of delay were identified as the patient wait at the theatre reception and in the operating suite before intubation. Mandibulectomy procedures were the longest procedures with approximately five (5) hours, followed by maxillectomy with four (4) hours and maxillofacial trauma with three and a half (3.5) hours. Maxillectomy procedures had highest transfusion probability. The surgical time and the estimated blood loss significantly determined whether a patient would be transfused or not. The nasotracheal was the commonest route of intubation while cleft surgeries were the most frequent procedures performed followed by trauma surgeries. Majority of the patients were not transfused and two units of blood was the most frequent transfused volume for a patient.

CONCLUSION

The main areas of delay have been identified as patients' waiting periods before the surgical procedures. The reasons why these delays occur need to be investigated and addressed to have an optimally functional facility. Reservation of blood for maxillofacial surgical procedures should be based on the anticipated need for blood transfusion for the particular procedure.