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Yokoyama Y, Sunagawa M, Kurimoto K, Sakai T, Nishida Y, Ebata T, Kodera Y. Financial burden of surgical treatment for retroperitoneal sarcoma. Surg Today 2024:10.1007/s00595-024-02831-z. [PMID: 38607396 DOI: 10.1007/s00595-024-02831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 04/13/2024]
Abstract
PURPOSES The purpose of this study was to compare the financial burden of surgery for retroperitoneal sarcoma (RPS) and gastric cancer (GC). METHODS All patients who underwent surgery for GC or RPS between 2020 and 2021 at Nagoya University Hospital were included. The clinical characteristics, surgical fees per surgeon, and surgical fees per hour were compared between the two groups. RESULTS The GC and RPS groups included 35 and 63 patients, respectively. In the latter group, 37 patients (59%) underwent tumor resection combined with organ resection; the most common organ was the intestine (n = 23, 37%), followed by the kidney (n = 16, 25%). The mean operative time (248 vs. 417 min, p < 0.001) and intraoperative blood loss (423 vs. 1123 ml, p < 0.001) were significantly greater in the RPS group than in the GC group. The mean surgical fee per surgeon was USD 1667 in the GC group and USD 1022 in the RPS group (p < 0.001) and USD 1388 and USD 777 per hour, respectively (p < 0.001). CONCLUSIONS The financial burden of surgical treatment for RPS is unexpectedly higher than that for GC.
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Affiliation(s)
- Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Masaki Sunagawa
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Keisuke Kurimoto
- Division of Gastroenterological Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohisa Sakai
- Department of Orthopedics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasuhiro Kodera
- Division of Gastroenterological Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Omura N, Hiramatsu R, Yagi R, Fujikawa Y, Fukumura M, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Takami T, Ohnishi H, Wanibuchi M. Comparison of outcomes with/without preoperative embolization for meningiomas with diluted N-butyl-2-cyanoacrylate. Clin Neurol Neurosurg 2024; 238:108178. [PMID: 38387239 DOI: 10.1016/j.clineuro.2024.108178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/27/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Preoperative embolization for meningiomas is controversial regarding its effectiveness in reducing intraoperative blood loss and operative time. In contrast, some reports have documented improved surgical outcomes in large meningiomas. In this study, we retrospectively compared the outcomes of craniotomy for meningiomas with/without preoperative embolization with diluted N-butyl-2-cyanoacrylate (NBCA) primarily in a single institution. METHODS Data (World Health Organization grade, Simpson grade, maximum tumor diameter, intraoperative bleeding, operative time, history of hypertension, and time from embolization to craniotomy) of patients with initial intracranial meningiomas were compared with or without preoperative embolization from January 2015 to April 2022. RESULTS The embolization group consisted of 56 patients and the nonembolization group included 76 patients. Diluted NBCA (13% concentration for all patients) was used in 51 of 56 patients (91.1%) who underwent transarterial embolization. Permanent neurological complications occurred in 2 (3.6%) patients. Intraoperative bleeding was significantly lower in the embolization group for a maximum tumor diameter ≥40 mm (155 vs. 305 ml, respectively, p < 0.01). In the nonembolization group, for a maximum tumor diameter ≥30 mm, patients with hypertension had more intraoperative bleeding than non-hypertensive ones. CONCLUSIONS Despite its limitations, the present results showed that, under certain conditions, preoperative embolization for intracranial meningiomas caused less intraoperative bleeding. The safety of treatment was comparable with that reported in the Japan Registry of NeuroEndovascular Therapy 3 (JR-NET3) with a complication rate of 3.7% for preoperative embolization of meningiomas, despite the treatment focused on the liquid embolization material.
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Affiliation(s)
- Naoki Omura
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Yoshiki Fujikawa
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masao Fukumura
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masahiro Kameda
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Naosuke Nonoguchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Hiroyuki Ohnishi
- Department of Neurosurgery, Eimeikai Ohnishi Neurological Center, Akashi City, Hyogo, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
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Huang L, Li QL, Yu QS, Peng H, Zhen Z, Shen Y, Zhang Q. Will partial splenic embolization followed by splenectomy increase intraoperative bleeding? World J Gastrointest Surg 2024; 16:318-330. [PMID: 38463347 PMCID: PMC10921206 DOI: 10.4240/wjgs.v16.i2.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/17/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Partial splenic embolization (PSE) has been suggested as an alternative to splenectomy in the treatment of hypersplenism. However, some patients may experience recurrence of hypersplenism after PSE and require splenectomy. Currently, there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications. AIM To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism. METHODS Between January 2010 and December 2021, 321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department. Based on whether PSE was performed prior to splenectomy, the patients were divided into two groups: PSE group (n = 40) and non-PSE group (n = 281). Patient characteristics, postoperative complications, and follow-up data were compared between groups. Propensity score matching (PSM) was conducted, and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding (IB). The receiver operating characteristic curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) were employed to evaluate the differentiation, calibration, and clinical performance of the model. RESULTS After PSM, the non-PSE group showed significant reductions in hospital stay, intraoperative blood loss, and operation time (all P = 0.00). Multivariate analysis revealed that spleen length, portal vein diameter, splenic vein diameter, and history of PSE were independent predictive factors for IB. A nomogram predictive model of IB was constructed, and DCA demonstrated the clinical utility of this model. Both groups exhibited similar results in terms of overall survival during the follow-up period. CONCLUSION Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.
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Affiliation(s)
- Long Huang
- Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Qing-Lin Li
- Anhui University of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, Hefei 230038, Anhui Province, China
| | - Qing-Sheng Yu
- Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Hui Peng
- Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Zhou Zhen
- Department of Surgery, The Second Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230061, Anhui Province, China
| | - Yi Shen
- Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Qi Zhang
- Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
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Maytal A, Naidorf Rosenblatt H, Rotem R, Segev F. Effect of direct oral anticoagulants on bleeding during and after cataract surgery. Int Ophthalmol 2024; 44:100. [PMID: 38376717 PMCID: PMC10879357 DOI: 10.1007/s10792-024-02944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE To assess the risk for intraoperative and postoperative ocular bleeding associated with direct oral anticoagulant treatment in patients undergoing phacoemulsification surgery. METHODS Consecutive patients had phacoemulsification and intraocular lens implantation while taking uninterrupted direct oral anticoagulants (dabigatran, rivaroxaban, or apixaban). Gender and age-matched patients without antithrombotic therapy were used as the control group. Patients were examined one week postoperatively. Intraoperative and postoperative hemorrhagic and non-hemorrhagic complications were assessed. RESULTS Forty patients (56 eyes) on direct oral anticoagulants and 120 patients (172 eyes) without anticoagulation, at a mean age of 77 years, had phacoemulsification. There was no significant difference between the groups in the rate of intraoperative and postoperative bleeding. One eye (1.8%) in the treatment group and 3 eyes (1.7%) in the control group had hyphema (p = 0.72). No patient had thromboembolic event during or after surgery. CONCLUSIONS Cataract surgery was safely performed while continuing direct oral anticoagulation.
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Affiliation(s)
- Anat Maytal
- Department of Ophthalmology, Meir Medical Center, Meir Hospital, 59 Tchernichovsky St, 4428164, Kfar Saba, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Fani Segev
- Department of Ophthalmology, Assuta-Samson Medical Center, Ashdod, Israel
- Joyce and Irwing Goldman Medical School, Ben-Gurion University, Beer-Sheva, Israel
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Deopujari CE, Ambekar S, Yetukuri BR, Diyora B, Ghosh A, Krishnan P, Panigrahi M, Ranjan R, Raman C, Tyagi S, Vaishya S, Venkataramana N, Sinha VD, Paniker D, Das S. Expert panel recommendations for topical hemostatic agent use in varied bleeding sites and situations during neuro-spine surgeries. J Clin Neurosci 2024; 120:30-35. [PMID: 38176112 DOI: 10.1016/j.jocn.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
Intraoperative bleeding poses a substantial challenge, particularly in neuro-spine surgeries leading to complications such as hematomas, infections, and hemodynamic instability. Despite their proven efficacy, use of topical hemostatic agents (THAs) lacks comprehensive published literature and guidelines particularly in the Indian setting. The present study provides the first-ever Indian expert panel recommendations for effective adjunct THA use in different intraoperative bleeding sites and situations in neuro-spine surgeries. A comprehensive approach, encompassing a literature review, followed by experience sharing in a meeting using a survey helped integrate expert opinions in the form of practical algorithms to guide THA selection. Our survey results revealed a strong inclination towards specific THAs, flowable gelatin + thrombin being choice of THA for difficult to access and problematic bleeding situations during tumor removal/resection, transsphenoidal hypophysectomy and skull-based procedures. Both oxidized regenerated cellulose (ORC)/Fibrillar and flowable gelatin + thrombin were recommended for continuous oozing. ORC/Fibrillar was preferred for arteriovenous and cavernous malformations. This expert-panel guidance on THA use aims to optimize hemostat use practices and improve surgical outcomes in neuro-spine surgery.
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Affiliation(s)
- C E Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - S Ambekar
- Department of Neurosurgery, Jaslok Hospital, Mumbai, India
| | - B R Yetukuri
- Department of Neurosurgery and Spine Surgery, Yashoda Hospitals, Hyderabad, India
| | - B Diyora
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - A Ghosh
- Department of Neurosurgery, Institute of Neurosciences Kolkata, Kolkata, India
| | - P Krishnan
- Department of Neurosurgery, National Neurosciences Centre Calcutta, Kolkata, India
| | - M Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, India
| | - R Ranjan
- Department of Neurosurgery, Aditya Birla Memorial Hospital, Pune, India
| | - C Raman
- Department of Neurosurgery, Nobel Hospital, Pune, India
| | - S Tyagi
- Department of Neurosurgery, Indraprastha Apollo Hospital, New Delhi, India
| | - S Vaishya
- Department of Neurosurgery, Fortis Memorial Research Institute, Gurugram, India
| | - N Venkataramana
- Department of Neurosurgery, Brains Hospital, Bengaluru, India
| | - V D Sinha
- Department of Neurosurgery, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - D Paniker
- Department of Neurosurgery, Aster Medcity, Kochi, India
| | - S Das
- Johnson and Johnson Private Limited, Mumbai, India.
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Lu YY, Li YX, He M, Wang YL. Laparoscopic vs open surgery for gastric cancer: Assessing time, recovery, complications, and markers. World J Gastrointest Surg 2024; 16:40-48. [PMID: 38328321 PMCID: PMC10845286 DOI: 10.4240/wjgs.v16.i1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Gastric cancer (GC) is one of the most common cancers worldwide. Morbidity and mortality have increased in recent years, making it an urgent issue to address. Laparoscopic radical surgery (LRS) is a crucial method for treating patients with GC; However, its influence on tumor markers is still under investigation. AIM To determine the effects of LRS on patients with GC and their serum tumor markers. METHODS The data of 194 patients treated at Chongqing University Cancer Hospital between January 2018 and January 2019 were retrospectively analyzed. Patients who underwent traditional open surgery and LRS were assigned to the control (n = 90) and observation groups (n = 104), respectively. Independent sample t-tests and χ2 tests were used to compare the two groups based on clinical efficacy, changes in tumor marker levels after treatment, clinical data, and the incidence of postoperative complications. To investigate the association between tumor marker levels and clinical efficacy in patients with GC, three-year recurrence rates in the two groups were compared. RESULTS Patients in the observation group had a shorter duration of operation, less intraoperative blood loss, an earlier postoperative eating time, and a shorter hospital stay than those in the control group (P < 0.05). No significant difference was observed between the two groups regarding the number of lymph node dissections (P > 0.05). After treatment, the overall response rate in the control group was significantly lower than that in the observation group (P = 0.001). Furthermore, after treatment, the levels of carbohydrate antigen 19-9, cancer antigen 72-4, carcinoembryonic antigen, and cancer antigen 125 decreased significantly. The observation group also exhibited a significantly lower incidence rate of postoperative complications compared to the control group (P < 0.001). Additionally, the two groups did not significantly differ in terms of three-year survival and recurrence rates (P > 0.05). CONCLUSION LRS effectively treats early gastric cancer by reducing intraoperative bleeding, length of hospital stays, and postoperative complications. It also significantly lowers tumor marker levels, thus improving the short-term prognosis of the disease.
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Affiliation(s)
- Yun-Yao Lu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Yun-Xiao Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Meng He
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Ya-Li Wang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
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Li J, Jia YM, Zhang ZL, Liu CY, Jiang ZW, Hao ZW, Peng L. Development and validation of a machine learning-based early prediction model for massive intraoperative bleeding in patients with primary hepatic malignancies. World J Gastrointest Oncol 2024; 16:90-101. [PMID: 38292843 PMCID: PMC10824121 DOI: 10.4251/wjgo.v16.i1.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/12/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Surgical resection remains the primary treatment for hepatic malignancies, and intraoperative bleeding is associated with a significantly increased risk of death. Therefore, accurate prediction of intraoperative bleeding risk in patients with hepatic malignancies is essential to preventing bleeding in advance and providing safer and more effective treatment. AIM To develop a predictive model for intraoperative bleeding in primary hepatic malignancy patients for improving surgical planning and outcomes. METHODS The retrospective analysis enrolled patients diagnosed with primary hepatic malignancies who underwent surgery at the Hepatobiliary Surgery Department of the Fourth Hospital of Hebei Medical University between 2010 and 2020. Logistic regression analysis was performed to identify potential risk factors for intraoperative bleeding. A prediction model was developed using Python programming language, and its accuracy was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS Among 406 primary liver cancer patients, 16.0% (65/406) suffered massive intraoperative bleeding. Logistic regression analysis identified four variables as associated with intraoperative bleeding in these patients: ascites [odds ratio (OR): 22.839; P < 0.05], history of alcohol consumption (OR: 2.950; P < 0.015), TNM staging (OR: 2.441; P < 0.001), and albumin-bilirubin score (OR: 2.361; P < 0.001). These variables were used to construct the prediction model. The 406 patients were randomly assigned to a training set (70%) and a prediction set (30%). The area under the ROC curve values for the model's ability to predict intraoperative bleeding were 0.844 in the training set and 0.80 in the prediction set. CONCLUSION The developed and validated model predicts significant intraoperative blood loss in primary hepatic malignancies using four preoperative clinical factors by considering four preoperative clinical factors: ascites, history of alcohol consumption, TNM staging, and albumin-bilirubin score. Consequently, this model holds promise for enhancing individualised surgical planning.
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Affiliation(s)
- Jin Li
- Department of Hepatological Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Yu-Ming Jia
- Department of Hepatological Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Zhi-Lei Zhang
- Department of Hepatological Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Cheng-Yu Liu
- Department of Hepatological Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Zhan-Wu Jiang
- Department of General Surgery II, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Zhi-Wei Hao
- Department of General Surgery II, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Li Peng
- Department of Hepatological Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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Calim M, Karaaslan K, Yilmaz S, Senturk E, Deniz H, Akbas S. The Effects of Hypocapnia and Hypercapnia on Intraoperative Bleeding, Surgical Field Quality, and Surgeon Satisfaction Level in Septorhinoplasty: A Prospective Randomized Clinical Study. Aesthetic Plast Surg 2024; 48:167-176. [PMID: 37407709 DOI: 10.1007/s00266-023-03433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/07/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Septorhinoplasty (SRP) is one of the most commonly performed procedures in the world for functional and aesthetic purposes. The present study was aimed to compare the effects of hypocapnia and hypercapnia regarding the total amount of intraoperative bleeding, surgical field quality, and surgeon satisfaction level. METHODS In this randomized prospective clinical study, eighty patients with American Society of Anesthesiologists I-II and were 18-45 years old scheduled for septorhinoplasty were randomly allocated to group hypocapnia [end-tidal carbon dioxide (EtCO2) 30 ± 2 mmHg] and group hypercapnia (EtCO2 40 ± 2 mmHg). We evaluated the total amount of intraoperative bleeding, the surgical field quality, surgeon satisfaction level, hemodynamics and peri- and postoperative adverse events. RESULTS Group hypocapnia significantly reduced the total amount of intraoperative bleeding (p < 0.001). The surgical field quality and surgeon satisfaction level in group hypocapnia were significantly better than group hypercapnia (p < 0.001). EtCO2 levels of group hypocapnia were significantly lower than group hypercapnia at all time points (p < 0.001 for all time points). There were no significant differences between the groups in terms of heart rate and mean arterial pressure at all time points. There were no significant differences between the groups in terms of adverse events CONCLUSIONS: The results of this double-blind randomized clinical trial showed that reducing the amount of intraoperative bleeding for patients with hypocapnia undergoing SRP through known methods (e.g., reverse Trendelenburg head-up position, positive end-expiratory pressure limiting, controlled hypotension, and use of topical vasoconstrictors, corticosteroids, and tranexamic acid) would improve the quality of the surgical field and raise the surgeon satisfaction level. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Kazim Karaaslan
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sinan Yilmaz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Erol Senturk
- Department of Otorhinolaryngology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Hilal Deniz
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sedat Akbas
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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9
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Fu BS, Zheng ZH. Severe intraoperative vascular bleeding as main complication of acetabular fractures treated with plate osteosynthesis via the modified Stoppa approach-Letter to editor. Injury 2023; 54:111056. [PMID: 37776781 DOI: 10.1016/j.injury.2023.111056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023]
Abstract
We read with great interest the article "Severe intraoperative vascular bleeding as the main complication of acetabular fractures treated with plate osteosynthesis via the modified Stoppa approach" by Julia Riemenschneider et al [1]. We appreciate the authors' efforts in describing intraoperative vascular bleeding in reduction acetabular fractures using the modified Stoppa approach. However, we had several concerns about the study results and believe that the authors' responses may help to address them.
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Affiliation(s)
- Bo-Shiang Fu
- Department of Orthopedic Surgery, National Defense Medical Center, Tri-Service General Hospital, #325, Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan; Zuoying Branch of Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan
| | - Zhi-Hong Zheng
- Department of Orthopedic Surgery, National Defense Medical Center, Tri-Service General Hospital, #325, Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan; Department of Orthopedic Surgery, Hualien Armed Forces General Hospital, Taiwan; Department of Orthopedic Surgery, Tri-Service General Hospital Keelung branch, Taiwan.
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10
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Chen WA, Huang HS, Lu ZH, Liu CJ. The Mayo adhesive probability score predicts postoperative fever and intraoperative hemorrhage in mini-percutaneous nephrolithotomy. World J Urol 2023; 41:2503-2509. [PMID: 37491630 DOI: 10.1007/s00345-023-04529-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE Contemporary predictive tools for miniaturized percutaneous nephrolithotomy (mPCNL) mainly focus on stone clearance but not perioperative complications, especially infection and hemorrhage. This study aimed to evaluate whether the Mayo adhesive probability (MAP) score, an index of the perinephric fat characteristics, can predict postoperative fever and intraoperative hemorrhage in mPCNL. METHODS This is a retrospective study recruiting 159 mPCNL patients from July 2018 to January 2022. MAP scores were recorded using preoperative computed tomography. Postoperative complications included postoperative fever and intraoperative bleeding, defined as hemoglobin drop. RESULTS Over half patients had the MAP score ≧ 3. Men, elderly, chronic kidney disease, and diabetes were associated with a higher MAP score. The patients with a higher MAP score were more likely to have postoperative fever after mPCNL. On multivariate analysis, preoperative positive urine culture (OR 2.68) and a higher MAP score (OR 2.28) were both significantly associated with postoperative fever. ROC curves analysis of the combination of these two factors on predicting postoperative fever showed AUC values were 0.731 (0.652-0.810). Moreover, a higher MAP score (OR 2.30) and longer operative time (OR 2.16) were significantly associated with higher hemoglobin drop on multivariate analysis. CONCLUSION A high MAP score was associated with postoperative fever and intraoperative hemorrhage in patients undergoing mPCNL. The MAP score can be a novel and easy predictive tool to help endourologists improve the awareness of mPCNL safety.
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Affiliation(s)
- Wei-An Chen
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan
| | - Ho-Shiang Huang
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan
| | - Ze-Hong Lu
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan
| | - Chan-Jung Liu
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan.
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Chen W, Jin K, Yu Z, Liu H. Analysis of risk factors and management of unexpected intraoperative bleeding during video-assisted thoracic surgery for non-small cell lung cancer: a case-control study. J Thorac Dis 2023; 15:2729-2741. [PMID: 37324062 PMCID: PMC10267922 DOI: 10.21037/jtd-23-305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023]
Abstract
Background Intraoperative bleeding is one of the most dangerous complications of thoracoscopic surgery and seriously endangers the life of patients. How to prevent and manage intraoperative bleeding is a core concern for every thoracic surgeon. The aim of our study was to analyze the related risk factors of unexpected intraoperative bleeding during video-assisted thoracoscopic surgery (VATS) and the strategies for managing bleeding. Methods A total of 1,064 patients who underwent anatomical pulmonary resection were analyzed retrospectively. According to the presence or absence of intraoperative bleeding, all cases were divided into an intraoperative bleeding group (IBG) and a reference group (RG). Clinicopathological characteristics and perioperative outcomes were compared in both groups. In addition, the sites, reasons, and coping strategies of intraoperative bleeding were summarized and analyzed. Results After rigorous screening, 67 patients with intraoperative bleeding and 997 patients without intraoperative bleeding were included in our study. Compared with the RG, among patients in the IBG, there was a higher incidence of history of chest surgery (P<0.001), higher incidence of pleural adhesion (P=0.015), higher incidence of squamous cell carcinoma (P=0.034), and the fewer early T-stage cases (P=0.003). In the multivariate analyses, a history of chest surgery (P=0.001) and T stage (P=0.010) were independent risk factors of intraoperative bleeding. The IBG was associated with the longer operative time, the more blood loss, the higher rates of intraoperative blood transfusion and conversion, the longer hospital stay and the more complications. There were no significant differences in the duration of chest drainage (P=0.066) between IBG and RG. The most common injury site of intraoperative bleeding was the pulmonary artery (72%). The commonest cause of intraoperative bleeding was the accidental injury of energy device (37%). The most frequently used method for managing intraoperative bleeding was suturing of the bleeding site (64%). Conclusions Although unexpected intraoperative bleeding during VATS is unavoidable, it can be controlled provided that positive and effective hemostasis are achieved. However, prevention is the priority.
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Affiliation(s)
- Wei Chen
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Kuanzhe Jin
- Department of Thoracic Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
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Riemenschneider J, Janko M, Vollrath T, Nau C, Marzi I. Severe intraoperative vascular bleeding as main complication of acetabular fractures treated with plate osteosynthesis via the modified Stoppa approach. Injury 2023:S0020-1383(23)00402-3. [PMID: 37193634 DOI: 10.1016/j.injury.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
Acetabular fractures are challenging fractures and finding the best supportive treatment is complex. Many operative treatment options exist - one of them is the plate osteosynthesis via the modified Stoppa approach gaining popularity over the last decades. The purpose of this study is to give an overview of this surgical techniques and its main complications. Patients ≥ 18 years between the years 2016 and 2022 with acetabular fractures in our department received a surgical intervention with plate fixation via the modified Stoppa approach. All protocols and documents during a patient's hospital stay were analyzed to find relevant perioperative complications concerning this operative technique. Between 01/2016 und 12/2022 75 patients with acetabular fractures were treated surgically in the author's institution with a plate osteosynthesis via the modified Stoppa approach. In 26.7 % (n = 20) of all cases, patients were confronted with one or more perioperative complications typical for this operation. Intraoperative venous bleedings were the main complication with 10.6 % (n = 8). Postoperative functional impairment of the obturator nerve and deep vein thrombosis occurred with 2.7 % (n = 2) and 9.3 % (n = 7). This retrospective study shows that plate fixation via the Stoppa approach is a good treatment option because of the excellent intraoperative overview of the fracture, but has its pitfalls and complications. Especially severe vascular bleedings must be taken into account and its management well known.
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Affiliation(s)
- Julia Riemenschneider
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University, Theodor-Stern-Kai 7, Frankfurt 60590, Germany.
| | - Maren Janko
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Tilmann Vollrath
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Christoph Nau
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
| | - Ingo Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University, Theodor-Stern-Kai 7, Frankfurt 60590, Germany
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13
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Nagarajah D, Kueh YC, Lazim NM, Abdullah B. The hemostatic effect of hot saline irrigation in endoscopic sinus surgery: a systematic review and meta-analysis. Syst Rev 2022; 11:246. [PMID: 36401259 PMCID: PMC9675124 DOI: 10.1186/s13643-022-02113-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A good control of intraoperative bleeding is key for adequate anatomical visualization during endoscopic sinus surgery (ESS). The objective of this review was to assess the practice of hot intranasal saline irrigation (HSI) in achieving intraoperative hemostasis and good surgical field quality during ESS. METHODS An electronic search was performed via PubMed, SCOPUS, Google Scholar, and Cochrane from inception to June 2022. The included trials were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. The primary outcome assessed was the intraoperative bleeding score of the surgical field. The mean arterial pressure, duration of the surgery, amount of blood loss and surgeon's satisfaction score were assessed as the secondary outcomes. The risk of bias for each study was evaluated using the Cochrane risk of bias tool. RESULTS A total of 254 records were identified after removal of duplicates. Based on the title and abstract 246 records were excluded, leaving seven full texts for further consideration. Five records were excluded following full text assessment. Three trials with a total of 212 patients were selected. Hot saline irrigation was superior to control in the intraoperative bleeding score (MD - 0.51, 95% CI - 0.84 to - 0.18; P < 0.001; I2 = 72%; very low quality of evidence) and surgeon's satisfaction score (RR 0.18, 95% CI 0.09 to 0.33; P < 0.001; I2 = 0%; low quality of evidence). The duration of surgery was lengthier in control when compared to HSI (MD - 9.02, 95% CI - 11.76 to - 6.28; P < 0.001; I2 = 0; very low quality of evidence). The volume of blood loss was greater in control than HSI (MD - 56.4, 95% CI - 57.30 to - 55.51; P < 0.001; I2 = 0%; low quality of evidence). No significant difference between the two groups for the mean arterial pressure was noted (MD - 0.60, 95% CI - 2.17 to 0.97; P = 0.45; I2 = 0%; low quality of evidence). CONCLUSIONS The practice of intranasal HSI during ESS is favorable in controlling intraoperative bleeding and improving the surgical field quality. It increases the surgeon's satisfaction, reduces blood loss, shortens operative time and has no effect on intraoperative hemodynamic instability. TRIAL REGISTRATION PROSPERO registration number: CRD42019117083.
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Affiliation(s)
- Darshini Nagarajah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Yee Cheng Kueh
- Unit Biostatistic and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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Kikuchi Y, Saijo Y, Narita M, Shibagaki K, Okubo R, Kunioka S, Shirasaka T, Kamiya H. Post-cardiotomy pericardial effusion and postoperative atrial fibrillation risk. Int J Cardiovasc Imaging 2022; 38:1873-1879. [PMID: 37726512 DOI: 10.1007/s10554-022-02560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Postoperative atrial fibrillation is a poor prognostic factor associated with increased mortality rates. Patients experiencing significant pericardial effusion develop postoperative atrial fibrillation; however, little is explored about the association between postoperative atrial fibrillation and post-cardiotomy pericardial effusion. This retrospective, single-center study included adult patients who underwent cardiovascular surgery via median sternotomy from January 2016 to December 2019. Patients who underwent routine postoperative computed tomography at 7 ± 3 days after surgery (n = 294) were included. Pericardial effusion was measured at the thickest point. Patients were classified into those with (n = 127) and without (n = 167) postoperative atrial fibrillation. The association of pericardial effusion with other factors was evaluated. A possible confounder-adjusted logistic regression analysis after multiple imputation was performed to obtain odds ratios for postoperative atrial fibrillation using previously published risk factors. Age, intraoperative bleeding volume, and pericardial effusion size were all significantly higher in the group with postoperative atrial fibrillation. Multivariate logistic regression after multiple imputation revealed that age, intraoperative bleeding volume, and postoperative pericardial effusion were significantly associated with postoperative atrial fibrillation. Our findings suggest that post-cardiotomy pericardial effusion is associated with postoperative atrial fibrillation. However, the causality remains unknown, making further studies mandatory.
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Affiliation(s)
- Yuta Kikuchi
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yasuaki Saijo
- Department of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Masahiko Narita
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Keisuke Shibagaki
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Ryo Okubo
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Shingo Kunioka
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Tomonori Shirasaka
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Hiroyuki Kamiya
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
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15
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Xu Q, Gong C, Qiao L, Feng R, Liu H, Liu Y, Yang L, Fan W, Guan L, Li J, Zhang Y, Li S. Downregulation of angiogenic factors in aqueous humor associated with less intraoperative bleeding in PDR patients with NVG receiving conbercept: a randomized controlled trial. BMC Ophthalmol 2022; 22:224. [PMID: 35585570 PMCID: PMC9115965 DOI: 10.1186/s12886-022-02451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze the level changes of 28 cytokines in aqueous humor of patients with proliferative diabetic retinopathy (PDR) coexisting neovascular glaucoma (NVG) after intravitreal injection of conbercept (IVC), and to investigate whether these cytokines are associated with intraoperative bleeding (IOB). METHODS Totally 34 eyes with NVG secondary to PDR were enrolled. Patients were randomized into two groups, and all of them underwent 25-gauge pars plana vitrectomy (PPV) combined with trabeculectomy. Group I, 18 eyes received IVC 3 days before PPV, and 100 µL aqueous humor was collected at the time of IVC pretreatment and 3 days later at the beginning of PPV respectively. Group II, 16 eyes received IVC after PPV, and 100 µL aqueous humor was collected only at the beginning of PPV. Aqueous humor from 19 eyes with age-matched cataract patients served as controls. Luminex bead-based multiplex array was used to measure the levels of 28 cytokines in aqueous humor. The baseline cytokine levels were compared among the three groups. All NVG patients were divided into IOB and non-bleeding (INB) groups. The cytokine levels of aqueous humor at the beginning of PPV were compared between group I and II, also between IOB and INB groups. IOB in NVG patients was graded according to vitreous bleeding amount. The correlation between cytokine levels and the grades of IOB were analyzed. RESULTS Compared with controls, the baseline levels of 18 cytokines associated with inflammation and angiogenesis showed significantly increased in group I and group II (all, P < 0.0167). The IOB rate as well as the levels of IL-4, IL-22, Ang-2, PLGF and VEGF-A in group I were significantly lower than in group II (all, P < 0.05). The levels of IL-4, IL-22, Ang-2, PLGF and VEGF-A were significantly lower in INB group than in IOB group (all, P < 0.05). The levels of IL-4, Ang-2, PLGF and VEGF-A were positively correlated with the grades of IOB in NVG patients (all, rs > 0.4, P < 0.05). CONCLUSIONS IVC 3 days before PPV combined with trabeculectomy reduces IOB in NVG patients, in which the downregulation of IL-4, Ang-2, PLGF and VEGF-A after IVC may be an underlying mechanism. TRIAL REGISTRATION ChiCTR2100048118 , retrospectively registered on 2 July 2021.
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Affiliation(s)
- Qing Xu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Chaoju Gong
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Lei Qiao
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Ruifang Feng
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Haiyang Liu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Yalu Liu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Liu Yang
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Wei Fan
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Lina Guan
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Jie Li
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Yipeng Zhang
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Suyan Li
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China.
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Takebayashi K, Murata S, Kaida S, Yamaguchi T, Otake R, Miyake T, Ueki T, Kojima M, Iida H, Maehira H, Mori H, Shimizu T, Tani M. Adverse impact of postoperative intra-abdominal infectious complications on cancer recurrence-related survival after curative gastric cancer surgery. Am J Surg 2022; 224:949-954. [PMID: 35599072 DOI: 10.1016/j.amjsurg.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to evaluate the impact of postoperative intra-abdominal infectious complications (PICs) on survival after surgery for gastric cancer. METHODS A total of 152 patients who underwent curative gastrectomy for gastric cancer were included. The effect of clinicopathological features and PICs on recurrence-free survival (RFS) and overall survival (OS) were investigated. RESULTS The median age was 67 years. The pathological stage was stage I (61), II (40), and III (51). Thirty-two patients (21.1%) had PICs: 9, pancreatic fistula; 14, anastomotic leakage; and 17, intra-abdominal abscess. The five-year RFS and OS rates were significantly lower in patients with PICs than in those without PICs (63.4 vs. 85.6%; p < 0.01 and 56.4 vs. 80.3%; p < 0.01, respectively). In multivariate analysis, intraoperative blood loss was an independent prognostic factor for PICs. CONCLUSIONS Patients with PICs had worse clinical outcomes. Reducing intraoperative bleeding may improve the prognosis of gastric cancer.
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Affiliation(s)
- Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Satoshi Murata
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan; Cancer Center, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Reiko Otake
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tomoyuki Ueki
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masatsugu Kojima
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tomoharu Shimizu
- Medical Safety Section, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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Koc EK, Besir A, Tugcugil E, Livaoğlu M. The effects of 5-degree, 10-degree and 20-degree reverse Trendelenburg positions on intraoperative bleeding and postoperative Edemea and ecchymosis around the eye in open rhinoplasty. Am J Otolaryngol 2022; 43:103311. [PMID: 34894451 DOI: 10.1016/j.amjoto.2021.103311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE In this study, we investigated the effect of reverse Trendelenburg position (RTP), with five, ten, and twenty degrees, on intraoperative bleeding and postoperative edema and ecchymosis around the eye in open rhinoplasty operations. MATERIALS AND METHODS Ninety patients undergoing open rhinoplasty were divided into three groups, 5° angle RTP (Group 5; n = 30), 10° angle RTP (Group 10; n = 30), and 20° angle RTP (Group 20; n = 30). After 3 min of preoxygenation, anesthesia was induced with 3 mg.kg-1 propofol, 1 μg.kg-1 fentanyl, and 0.6 mg/kg rocuronium for muscle relaxation. Maintenance of anesthesia was provided with a minimum alveolar concentration of 1-1.5 with sevoflurane, 1:1 O2/N2O. Hemodynamic variables, intraoperational bleeding, postoperative 1st, 3rd and 7th days ecchymosis and edema around the eyes of the patients were compared between the groups. RESULTS Edema changes on postoperative 1st, 3rd and 7th days and ecchymosis changes around the eyes on postoperative 1st and 3rd days in Group 20 were found significantly lower than Group 5 (p < 0.017). Besides, the change of ecchymosis on the postoperative 1st day was found significantly lower in Group 20 compared to Group 10 (p < 0.017). The amount of intraoperative bleeding and surgical field evaluation score were found to be significantly lower in Group 10 and Group 20 compared to Group 5 (p < 0.017). CONCLUSION We concluded that in open rhinoplasty surgeries, 20° degree RTP reduces intraoperative blood loss and provides a more bloodless surgical field, as well as reducing edema and ecchymoses around the eyes in the postoperative period.
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Sugahara K, Koyama Y, Koyachi M, Watanabe A, Kasahara K, Takano M, Katakura A. A clinico-statistical study of factors associated with intraoperative bleeding in orthognathic surgery. Maxillofac Plast Reconstr Surg 2022; 44:7. [PMID: 35212834 PMCID: PMC8881570 DOI: 10.1186/s40902-022-00336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Excessive bleeding is a major intraoperative risk associated with orthognathic surgery. This study aimed to investigate the factors involved in massive bleeding during orthognathic surgeries so that safe surgeries can be performed. Patients (n=213) diagnosed with jaw deformities and treated with bimaxillary orthognathic surgery (Le Fort I osteotomy and bilateral sagittal split ramus osteotomy) in the Department of Oral and Maxillofacial Surgery at the Suidobashi Hospital, Tokyo Dental College between January 2014 and December 2016 were included. Using the patients’ medical and operative records, the number of cases according to sex, age at the time of surgery, body mass index (BMI), circulating blood volume, diagnosis of maxillary deformity, direction of maxillary movement, operative duration, incidence of bad split, injury of nasal mucosa, and blood type were analyzed. Results The results revealed that BMI, circulating blood volume, nasal mucosal injury, and operative time were associated with the risk of intraoperative massive bleeding in orthognathic surgeries. Chi-square tests and binomial logistic regression analyses showed significant differences in BMI, circulating blood volume, direction of maxillary movement, operative duration, and injury to the nasal mucosa. Operative duration emerged as the most important risk factor. Furthermore, a >4-mm upward migration of the posterior nasal spine predicted the risk of massive bleeding in orthognathic surgery. Conclusions The upward movement of the maxilla should be recognized during the preoperative planning stage as a risk factor for intraoperative bleeding, and avoiding damage to the nasal mucosa should be considered a requirement for surgeons to prevent massive bleeding during surgery.
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Affiliation(s)
- Keisuke Sugahara
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan. .,Oral Health Science Center, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
| | - Yu Koyama
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Masahide Koyachi
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Akira Watanabe
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Kiyohiro Kasahara
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Masayuki Takano
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Akira Katakura
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.,Oral Health Science Center, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
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Afzali SL, Panahi H, Ganji F, Ziaei S, Sedaghat N. Re-Evaluating the Effect of Preoperative Tranexamic Acid on Blood Loss and Field Quality During Rhinoplasty: A Randomized Double-Blinded Controlled Trial. Aesthetic Plast Surg 2021; 46:1314-1320. [PMID: 34585263 DOI: 10.1007/s00266-021-02594-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Nowadays, minimizing the surgical complications of rhinoplasty has gained more importance. Results from previous trials show that Tranexamic acid (TXA) reduces intraoperative bleeding, one of the major complicating factors during rhinoplasty. OBJECTIVE To contribute to previous evidence by re-evaluating the efficacy of TXA, specifically in reducing intraoperative blood loss and increasing surgical field quality in rhinoplasty. STUDY DESIGN AND METHODS A randomized placebo-controlled trial was conducted (IRCT20111219008458N2). The outcomes included total intraoperative blood loss, measured by the total volume of fluid collected by suction and gauzes, subtracted by volume of used irrigation fluids, and the quality of surgical field, measured by surgeon's satisfaction on a 5-point Likert scale. Demographics, blood coagulation measures, and clinical data were also collected and were held as covariates in analysis. After blinding, randomization, and group allocations, the intervention group received TXA 10mg/kg and the placebo group normal saline in equal volumes. RESULTS Data of a total of 80 patients were gathered and analyzed. The total intraoperative blood loss was insignificantly lower (mean difference [95% CI]: - 3.6 ( - 19.19, 11.99), P = 0.65) and surgeon's satisfaction was insignificantly higher (mean difference [95% CI]: 0.18 ( - 0.11, 0.46), P = 0.22) in TXA group. Results were confirmed by multivariable analysis. CONCLUSION In contrast to most of the previous studies, this study showed only a statistically insignificant decrease in total intraoperative blood loss in patients receiving TXA compared to placebo. Further studies are required to more precisely estimate the efficacy of TXA in reducing blood loss during rhinoplasty. LEVEL OF EVIDENCE LEVEL I, RANDOMIZED CONTROLLED TRIAL.: 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 .
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Affiliation(s)
- Sayed Lotfollah Afzali
- Department of Surgery, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hesam Panahi
- Department of Surgery, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Forouzan Ganji
- Department of Community Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sanaz Ziaei
- Department of Pediatric Dentistry, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahad Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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Prastikarunia R, Wahyuhadi J, Susilo RI, Haq IBI. Tranexamic acid to reduce operative blood loss in brain tumor surgery: A meta-analysis. Surg Neurol Int 2021; 12:345. [PMID: 34345485 PMCID: PMC8326094 DOI: 10.25259/sni_19_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Major blood loss during neurosurgery may result in a variety of complications, such as potentially fatal hemodynamic instability. Brain tumor and skull base surgery is among the high bleeding risk procedures. Tranexamic acid (TXA) has been found to reduce bleeding events in various fields of medicine. Methods: We searched for all randomized controlled trials published in English or Bahasa which compared the use of TXA with placebo in brain tumor surgery. The studies should include adult patients with intracranial tumor who received TXA before skin incision. The primary and secondary outcomes are intraoperative blood loss and the need of transfusion. Results: This meta-analysis included a total of 200 patients from three studies. TXA resulted in less blood loss with pooled mean difference of −292.80 (95% CI, −431.63, −153.96, P<0.05). The need of transfusion was not significant between TXA and control group (pooled mean difference −85.36, 95% CI, −213.23 – (42.51), P=0.19). Conclusion: TXA reduced the volume of blood loss but did not reduce the need of blood transfusion.
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Affiliation(s)
- Resi Prastikarunia
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Rahadian Indarto Susilo
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Irwan Barlian Immadoel Haq
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
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Sgaramella LI, Gurrado A, Pasculli A, de Angelis N, Memeo R, Prete FP, Berti S, Ceccarelli G, Rigamonti M, Badessi FGA, Solari N, Milone M, Catena F, Scabini S, Vittore F, Perrone G, de Werra C, Cafiero F, Testini M. The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study. Surg Endosc 2021; 35:3698-3708. [PMID: 32780231 PMCID: PMC8195809 DOI: 10.1007/s00464-020-07852-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. METHODS Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. RESULTS Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. CONCLUSIONS The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.
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Affiliation(s)
- Lucia Ilaria Sgaramella
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Angela Gurrado
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Alessandro Pasculli
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Nicola de Angelis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Paolo Prete
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Stefano Berti
- Department of General Surgery, “Sant’Andrea” Hospital La Spezia, La Spezia, Italy
| | - Graziano Ceccarelli
- Division of General Surgery, Department of Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100 Arezzo, Italy
| | | | | | - Nicola Solari
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Federico II” University, Napoli, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
| | - Stefano Scabini
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Vittore
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Gennaro Perrone
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
| | - Carlo de Werra
- Department of Clinical Medicine and Surgery, Federico II” University, Napoli, Italy
| | - Ferdinando Cafiero
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Mario Testini
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
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Kobayashi K, Matsumoto F, Miyakita Y, Arikawa M, Omura G, Matsumura S, Ikeda A, Sakai A, Eguchi K, Narita Y, Akazawa S, Miyamoto S, Yoshimoto S. Risk Factors for Delayed Surgical Recovery and Massive Bleeding in Skull Base Surgery. Biomed Hub 2020; 5:87-100. [PMID: 32775338 PMCID: PMC7392383 DOI: 10.1159/000507750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To determine factors that delay surgical recovery and increase intraoperative hemorrhage in skull base surgery. METHODS Factors related to delayed postoperative recovery were retrospectively reviewed in 33 patients who underwent open skull base surgery. Early and late recovery phases were assessed as "days required to walk around the ward (DWW)" and "length of hospital stay (LHS)," respectively. Intraoperative blood loss was cal-culated every hour and analyzed in 4 steps, i.e., craniotomy and intracranial manipulation, cranial fossa osteotomy, extracranial osteotomy, and reconstruction. RESULTS More than 4,000 mL of blood loss (B = 2.7392, Exp[B] = 15.4744; 95% CI 1.1828-202.4417) and comorbidi-ty (B = 2.3978, Exp[B]) = 10.9987; 95% CI 1.3534-98.3810) significantly prolonged the DWW; the occurrence of postoperative complications significantly delayed the LHS (p = 0.0316). Tumor invasion to the hard palate, the maxillary sinus, the pterygopalatine fossa, the base of the pterygoid process, the sphenoid sinus, the middle cranial fossa, and the cavernous sinus and a long operation time (>13 h) were associated with increased total hemorrhage. The optimal cut-off hemorrhage volume associated with total massive blood loss in craniotomy and intracranial manipulation (AUC = 0.8364), cranial fossa osteotomy (AUC = 0.8000), and extracranial osteotomy (AUC = 0.8545) was 1,111, 750, and 913 mL, respectively. Persistent infection (6%) and neuropsychiatric disorder (6%) are direct causes of delayed LHS. CONCLUSION Blood loss, comorbidity, and postoperative complications were risk factors for delayed surgical recovery. Meticulous preoperative planning, intraoperative surefire hemostasis, and perioperative holistic management are prerequisites for safe skull base surgery.
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Affiliation(s)
- Kenya Kobayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuji Miyakita
- Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masaki Arikawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Go Omura
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Satoko Matsumura
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Atsuo Ikeda
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Azusa Sakai
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kohtaro Eguchi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Akazawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shimpei Miyamoto
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
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Bosch P, Kenkre TS, Soliman D, Londino JA, Novak NE. Comparison of the Coagulation Profile of Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion With and Without Tranexamic Acid. Spine Deform 2019; 7:910-916. [PMID: 31732001 DOI: 10.1016/j.jspd.2019.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Prospective, observational cohort study. OBJECTIVE To improve the understanding of coagulation and bleeding mechanisms during spinal deformity surgery. SUMMARY OF BACKGROUND DATA Fibrinolysis is the mechanism of bleeding for adolescent idiopathic scoliosis undergoing posterior spinal fusion. Antifibrinolytics have become popular; however, literature to support their use remains mixed. The mechanism of action has not been demonstrated. METHODS The coagulation profile of 88 adolescent idiopathic scoliosis patients undergoing posterior spinal fusion was analyzed. Standard coagulation laboratory investigations and thromboelastograms were drawn hourly through the case. Fifty-eight patients received no antifibrinolytic, whereas 30 patients received tranexamic acid by standardized protocol. The coagulation parameters, estimated blood loss, and transfusion requirements were compared in the two groups. RESULTS The two cohorts had no differences in demographic or surgical characteristics. Mean age was 13.6 years, 83% were female, a mean of 11.1 levels were fused, and the mean duration of surgery was 209 minutes. The tranexamic acid cohort did not demonstrate a decrease in blood loss. The transfusion rate, however, dropped from 47% in the non-tranexamic acid cohort to 23% in the tranexamic acid cohort (p = .03). Standard coagulation parameters did not differ between the groups. Fibrinolysis was diminished in the tranexamic acid cohort as measured by a Fibrinolysis score (mean maximum value 2.0 without tranexamic acid vs. 0.7 with tranexamic acid, p < .0001) and the lysis percent at 30 minutes by thromboelastogram (elevated to 3.9% without tranexamic acid vs. 1.2% with tranexamic acid at the 3-hour mark, p = .05). CONCLUSIONS This study provides confirmation of antifibrinolytic activity during posterior spinal fusion for adolescent idiopathic scoliosis. The presented data of fibrinolysis are proposed as standard measurements for future work on controlling blood loss during scoliosis surgery. LEVEL OF EVIDENCE Level 2, prospective comparative study.
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Affiliation(s)
- Patrick Bosch
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 4th Floor, Pittsburgh, PA 15224, USA.
| | - Tanya S Kenkre
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Public Health Building, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Doreen Soliman
- Department of Anesthesia, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 4th Floor, Pittsburgh, PA 15224, USA
| | - Joanne A Londino
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 4th Floor, Pittsburgh, PA 15224, USA
| | - Natalie E Novak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 4th Floor, Pittsburgh, PA 15224, USA
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Barequet IS, Zehavi-Dorin T, Bourla N, Tamarin I, Moisseiev J, Salomon O. Safety of cataract surgery in patients treated with the new oral anticoagulants (NOACs). Graefes Arch Clin Exp Ophthalmol 2019; 257:2671-2676. [PMID: 31641883 DOI: 10.1007/s00417-019-04488-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the safety of phacoemulsification of cataract in patients taking new oral anticoagulants (NOACs). METHODS In a prospective case series, consecutive patients on NOACs (dabigatran, rivaroxaban, or apixaban) who were referred for uncomplicated cataract surgery to the eye institute underwent a thorough ophthalmological and hematological evaluation. Rivaroxaban and apixaban anti-factor Xa tests, and diluted thrombin time for dabigatran, were used for monitoring anticoagulation levels in blood. Blood was drawn for these tests just prior to surgery and at a peak level of the drug at about 4 h post-surgery (2 h after the drug was given). All surgeries were videotaped and patients were examined at 1 and 7 days after the operation. The main outcome measures included assessment of intra-operative, postoperative ocular bleeding, and other related complications. RESULTS Thirty-five eyes of 25 unrelated patients ranging in age from 63 to 92 years (mean 77.6 years) underwent phacoemulsification. Intra-operative bleeding was observed in 5 eyes from the conjunctiva or limbus at the main incision site. No intraocular bleeding occurred. No hemorrhagic complications were observed during the 1-week follow-up. According to anti-factor Xa levels prior to surgery and following surgery, 85% of the patients were on therapeutic levels of NOACs. CONCLUSIONS Clear corneal incision phacoemulsification performed under topical anesthesia can be safely performed in simple cases of cataract without discontinuing NOAC treatment.
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Affiliation(s)
- Irina S Barequet
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel.
| | - Tzukit Zehavi-Dorin
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel
| | - Nirit Bourla
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel
| | - Ilia Tamarin
- Institute of Thrombosis & Hemostasis, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv, University, Tel Hashomer, Israel
| | - Joseph Moisseiev
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv University, Tel Hashomer, Israel
| | - Ophira Salomon
- Institute of Thrombosis & Hemostasis, Sheba Medical Center, Sackler Faculty of Medicine, Tel - Aviv, University, Tel Hashomer, Israel
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Singh J, Bhardwaj B. The Comparison between Microdebrider Assisted Adenoidectomy and Coblation Adenoidectomy: Analyzing the Intraoperative Parameters and Post-operative Recovery. Indian J Otolaryngol Head Neck Surg 2019; 72:59-65. [PMID: 32158657 DOI: 10.1007/s12070-019-01736-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022] Open
Abstract
Microdebrider adenoidectomy and Coblation adenoidectomy are the two new techniques available for adenoidectomy these days. The advantages of endoscopic power assisted adenoidectomy over cold steel adenoidectomy has been well established in the literature. As adenoidectomy is one of the most common paediatric surgical procedure there is always a concern to improve the outcomes and make postoperative experience more pleasant for the paediatric population. Cost difference between a coblator wand and microdebrider blade is always a confounding factor in decision making. The present study was conducted to compare both the techniques of adenoidectomy in terms of certain intraoperative and post operative parameters. The present study was a prospective randomized single blind study conducted in a university hospital on 140 subjects. The patients diagnosed with chronic adenoiditis grade 3-4 were randomly allocated in two groups after following the exclusion and inclusion criteria. the adenoidectomy in two groups; Microdebrider group and Coblation group were compared in terms of intraoperative time, post operative pain score; intraoperative bleeding, surgical field and some common complications. The data was analysed for significance by various statistical tests. The average adenoid size operated in both groups was Grade 3. The intraoperative time taken to complete the procedure in group A was 12.78 ± 3.8 min and in group B was 22 ± 3.3 min with p value < 0.05. There was statistically significant difference in grade of Intraoperative Bleeding in both groups with mean grade of intraoperative bleeding being 1.4 ± 1.04 in group B and 3.5 ± 0.9 in Group A. The surgical field was poor to average in 33 cases (n = 70) in group A as compared to only 1 case (n = 70) in group B; the difference being statistically significant. The average post-operative pain score was 2.69 ± 0.99 and 1.17 ± 1.1 after post-operatively 24 h and 72 h respectively in group B; 7.14 ± 0.99 and 4.08 ± 1.42 respectively in group A. The p value for the same was < 0.05. However there was no statistically significant difference between two groups in terms of any complications or completeness of removal. Though both the techniques are highly efficacious in adenoid removal and low complication rate in our study but still more studies with large sample size are encouraged to validate these results and establish the comparative efficacy of both the techniques in terms of the intraoperative parameters as well as post-operative recovery along with recurrence rates.
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Affiliation(s)
- Jaskaran Singh
- Sri Guru Ram Das Institute of Health Sciences and Research, Amritsar, India.,Mohali, India
| | - Bhanu Bhardwaj
- Sri Guru Ram Das Institute of Health Sciences and Research, Amritsar, India.,Amritsar, India
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Parvizi A, Haddadi S, Faghih Habibi A, Nemati S, Akhtar N, Ramezani H. Dexmedetomidine Efficacy in Quality of Surgical Field During Endoscopic Sinus Surgery. Iran J Otorhinolaryngol 2019; 31:281-288. [PMID: 31598495 PMCID: PMC6764817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Blood loss is a common concern during functional endoscopic sinus surgery (FESS). The present study aimed to evaluate the efficacy of dexmedetomidine (DEX) in intraoperative bleeding and surgical field in FESS. MATERIALS AND METHODS This double-blind randomized clinical trial was conducted on 72 patients within the age range of 16-60 years who underwent FESS. The subjects were randomly dividedinto two groups. The DEXgroup received 1 mic/kg DEX in 10 min at anesthesia induction followed by 0.4 to 0.8 mic/kg/hour during maintenance, while the control group received normal saline instead of DEX in bolus with the same volumemaintenance. Heart rate, systolic blood pressure, diastolic blood pressure (DBP),mean arterial pressure (MAP),and opioid requirement were evaluated in the 15th, 30th, 60th, and 90thmin of the induction. The surgeon's assessment of the field during surgery and intraoperative bleeding was also recorded in this study. RESULTS The DEX group had lower bleeding scores (P=0.001) than the control group.Surgeon's satisfaction based on a Likert scale (P=0.001) was lower in the control group. The mean of DBP was lower in the DEX group in the 30th(P=0.001), 60th(P=0.001), and 90th(P=0.01) min of the induction. The MAP was lower in the DEX group in the 30th(P=0.015), 60th(P=0.052), and 90th(P=0.046) min of the induction. There were no postoperative adverse effects in the DEX group. CONCLUSION It was observed that DEX improves the quality of the surgical field and hemodynamic stability. In addition, DEX might be safely and effectively used in surgeries in which deliberate hypotension is desirable.
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Affiliation(s)
- Arman Parvizi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital ,Guilan University of Medical Sciences, Rasht, Iran.
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital ,Guilan University of Medical Sciences, Rasht, Iran.,Corresponding Author: Anesthesiology Research Center,Department of Anesthesiology, Alzahra Hospital,Guilan University of Medical Sciences, Rasht, Iran; Tel: +98 9111323739, E-mail:
| | - Ali Faghih Habibi
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Shadman Nemati
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Nikoo Akhtar
- Student of Medicine,Guilan University of Medical Sciences, Rasht, Iran.
| | - Hedieh Ramezani
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Abstract
Intraoperative intraocular bleeding can present a major challenge during anterior segment operations, such as cataract and glaucoma surgery. In the presence of significant intraocular bleeding, the surgeon may be unable to proceed if the bleeding cannot be controlled. Uncontrolled bleeding may also result in intraoperative or postoperative complications. Intracameral injection of phenylephrine was used in three consecutive cases of intraoperative anterior chamber bleeding during cataract surgery, one of which was combined with CyPass® Micro-Stent insertion. This resulted in complete cessation of bleeding within a minute of the injection. No further intraoperative or postoperative hemorrhage was seen. As far as we know, this is the first report of intracameral phenylephrine use intraoperatively to successfully stop anterior chamber bleeding, enabling safe completion of surgery.
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Affiliation(s)
- Mukhtar Bizrah
- The Western Eye Hospital, Imperial College NHS Trust, London, UK.
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Yi J, Liang H, Song R, Xia H, Huang Y. Maintaining intraoperative normothermia reduces blood loss in patients undergoing major operations: a pilot randomized controlled clinical trial. BMC Anesthesiol 2018; 18:126. [PMID: 30193571 PMCID: PMC6129003 DOI: 10.1186/s12871-018-0582-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 08/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background Inadvertent intraoperative hypothermia (core temperature < 36 °C) is a common but preventable adverse event. This study aimed to determine whether active intraoperative warming reduced bleeding in patients undergoing major operations: open thoracic surgery and hip replacement surgery. Methods/Design The study was a pilot, prospective, parallel two-arm randomized controlled trial. Eligible patients were randomly allocated to two groups: passive warming (PW), with application of a cotton blanket (thermal insulation), or active warming (AW), with a forced-air warming system. The primary endpoint was intraoperative blood loss, and secondary endpoints were surgical-site infection, cardiovascular events, and length of stay in the post-anesthesia care unit, intensive care unit, and hospital. Results Sixty-two patients were enrolled. Forced-air active warming maintained intraoperative normothermia in all AW subjects, whereas intraoperative hypothermia occurred in 21/32 (71.8%) of PW patients (p = 0.000). The volume of blood loss was more in the PW group (682 ± 426 ml) than in the AW group (464 ± 324 ml) (p < 0.021), and the perioperative hemoglobin value declined more in the PW group (28.6 ± 17.5 g/L) than in the AW group (21.0 ± 9.9 g/L) (p = 0.045). However, there were no difference in other clinical outcomes between two groups. Conclusion Intraoperative active warming is associated with less blood loss than passive warming in open thoracic and hip replacement operations in this pilot study. Trial registration This trial was registered with Clinicaltrials.gov (Identifier: NCT02214524) on 27 August 2014.
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Affiliation(s)
- Jie Yi
- Department of Anesthesia, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Hao Liang
- Department of Anesthesia, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Ruiyue Song
- Department of Anesthesia, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Hailu Xia
- Department of Anesthesia, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesia, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Abstract
Background The incidence of cardiovascular and neurovascular diseases has been increasing with the aging of the population, and antiplatelet drugs (APDs) are more frequently used than in the past. With the average age of spinal surgery patients also increasing, there has been a great concern on the adverse effects of APD on spine surgery. To our knowledge, though there have been many studies on this issue, their results are conflicting. In this study, we aimed to determine the influence of APDs on spine surgery in terms of intraoperative bleeding and postoperative spinal epidural hematoma complication. Methods Patients who underwent posterior thoracolumbar decompression and instrumentation at our institution were reviewed. There were 34 APD takers (APDT group). Seventy-nine non-APD takers (NAPDT group) were selected as a control group in consideration of demographic and surgical factors. There were two primary endpoints of this study: the amount of bleeding per 10 minutes and cauda equina compression by epidural hematoma measured at the cross-sectional area of the thecal sac in the maximal compression site on the axial T2 magnetic resonance imaging scans taken on day 7. Results Both groups were homogeneous regarding age and sex (demographic factors), the number of fused segments, operation time, and primary/revision operation (surgical factors), and the number of platelets, prothrombin time, and activated partial thromboplastin time (coagulation-related factors). However, the platelet function analysis-epinephrine was delayed in the APDT group than in the NAPDT group (203.6 seconds vs. 170.0 seconds, p = 0.050). Intraoperative bleeding per 10 minutes was 40.6 ± 12.8 mL in the APDT group and 43.9 ± 9.9 mL in the NAPDT group, showing no significant difference between the two groups (p = 0.154). The cross-sectional area of the thecal sac at the maximal compression site by epidural hematoma was 120.2 ± 48.2 mm2 in the APDT group and 123.2 ± 50.4 mm2 in the NAPDT group, showing no significant difference between the two groups (p = 0.766). Conclusions APD medication did not increase intraoperative bleeding and postoperative spinal epidural hematoma. Therefore, it would be safer to perform spinal surgery without discontinuation of APD therapy in patients who are vulnerable to cardiovascular and neurovascular complications.
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Affiliation(s)
- Won Shik Shin
- Department of Orthopedics, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Dong Ki Ahn
- Department of Orthopedics, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Jung Soo Lee
- Department of Orthopedics, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - In Sun Yoo
- Department of Orthopedics, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Ho Young Lee
- Department of Orthopedics, Seoul Sacred Heart General Hospital, Seoul, Korea
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Miki K, Yagi K, Nonaka M, Iwaasa M, Abe H, Morishita T, Arima H, Inoue T. Intraoperative Active Bleeding in Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage is Predicted by the Spot Sign. World Neurosurg 2018; 116:e513-8. [PMID: 29758369 DOI: 10.1016/j.wneu.2018.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Endoscopic evacuation of hematoma (EEH) has recently been applied to treat patients with spontaneous intracerebral hemorrhage (sICH). Intraoperative active bleeding (IAB), which is occasionally observed in EEH, might lead to greater blood loss, further brain damage, and more postoperative recurrent hemorrhage. However, no definite predictor of IAB has been established. Because the spot sign is associated with other hemorrhagic complications, we aimed to evaluate whether it predicts IAB. METHODS We retrospectively assessed the incidence and risk factors of IAB, including the spot sign, in 127 sICH patients who underwent EEH within 6 hours after computed tomography angiography at our institution between June 2009 and December 2017. RESULTS The study included 53 women and 74 men with an average age of 66.7 ± 11.8 years. IAB occurred in 40 (31.5%) of the 127 patients, and it was more frequent in patients with the spot sign than in patients without it (14/24 [58.3%] vs. 26/103 [25.2%]; P = 0.003). Multivariable regression analyses suggested that the spot sign was an independent predictor of IAB (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.10-8.30; P = 0.03). In addition, earlier surgery gradually increased the risk of IAB, and surgery within 4 hours of onset was an independent risk factor (OR, 4.34; 95% CI, 1.12-16.9; P = 0.03, referring to postonset 8 hours or more). CONCLUSIONS The spot sign and early surgery were independent predictors of IAB in EEH for sICH. In patients with sICH and spot sign, complete treatment of IAB by electrocoagulation might be important for minimizing surgical complications.
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Singh A, Ganpule A. Rescue stitch: A minimal access surgeon's lifeboat in life-threatening intraoperative bleeding. J Minim Access Surg 2018; 15:84-87. [PMID: 29582797 PMCID: PMC6293683 DOI: 10.4103/jmas.jmas_186_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Bleeding in a minimal access surgery can be very intimidating for a laparoscopic surgeon. Open conversion becomes an imminent option in these situations. Although open conversion is not a surgical defeat, in certain situations, bleeding can be salvaged using a ‘rescue stitch.’ We, herein, describe rescue stitch along with a rescue tray and its application during intraoperative bleeding in minimal access surgery.
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Affiliation(s)
- Abhishek Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Garcia-Granero A, Sánchez-Guillén L, Frasson M, Sancho Muriel J, Alvarez Sarrado E, Fletcher-Sanfeliu D, Flor Lorente B, Pamies J, Corral Rubio J, Valverde Navarro AA, Martinez Soriano F, Garcia-Granero E. How to reduce the superior mesenteric vein bleeding risk during laparoscopic right hemicolectomy. Int J Colorectal Dis 2018; 33:235-239. [PMID: 29204697 DOI: 10.1007/s00384-017-2940-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The superior right colic vein (SRCV) has been proposed as the main cause of superior mesenteric vein bleeding by avulsion during laparoscopic right hemicolectomy. Our objective is to identify the main vessel causing transverse mesocolic tension during the extraction of the surgical specimen or extracorporeal anastomosis and to perform an anatomical description of the SRCV. METHODS In this cadaveric study, we performed a simulation of right hemicolectomy and anatomical description of the surgical area of the gastrocolic trunk of Henle (SAGCTH), the gastrocolic trunk of Henle (GCTH), and SRCV. The length of the exteriorization of the anastomotic transverse colon (ATC) was measured before and after sectioning the vascular vessel causing the exteriorization tension. RESULTS Five fresh cadavers and 12 formalin were dissected. In 100% of the specimens, the SRCV was present and drained in 95% into the GCTH and in 5% directly into the superior mesenteric vein (SMV). In 100% of the specimens, the SRCV caused the tension when extracting the ATC. The mean length of exteriorization of the ATC before and after SRCV section was 7.2 and 10.4 cm in formalin cadavers, meaning a 44% of increment in the length of exteriorization. In fresh cadavers, the mean length of exteriorization increased to 2.7 cm, meaning a 28% of the initial length of exteriorization. CONCLUSIONS The SRCV is the main cause of tension in the extraction of the surgical specimen after right hemicolectomy. Its high tie increases the length of the ATC exteriorization, in about 3 cm, and could reduce the risk of SMV bleeding during laparoscopic right hemicolectomy and facilitate an extracorporeal anastomosis free of tension.
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Affiliation(s)
- Alvaro Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain.
| | - Luis Sánchez-Guillén
- Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - Matteo Frasson
- Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - Jorge Sancho Muriel
- Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | | | | | - Blas Flor Lorente
- Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - Jose Pamies
- Hospital Universitario y Politecnico la Fe, Valencia, Spain
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Scarci M, Gonzalez-Rivas D, Schmidt J, Bedetti B. Management of Intraoperative Difficulties During Uniportal Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2017; 27:339-346. [PMID: 28962706 DOI: 10.1016/j.thorsurg.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The learning curve of the uniportal video-assisted thoracoscopic surgery (VATS) approach is linked to a larger rate of intraoperative complications, which can lead to an emergency conversion to thoracotomy. Despite technical advancements and the large number of surgical videos posted on specialized websites, live surgery events and experimental courses have significantly contributed to accelerate the learning and evolution of minimally invasive thoracic surgery. Bleeding and other complications are the most dreaded event for many VATS surgeons. This article analyzes possible major intraoperative complications during uniportal VATS and explains how to manage them effectively and safely.
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Affiliation(s)
- Marco Scarci
- Department of Thoracic Surgery, University College London Hospitals, 15-18 Westmoreland Street, London W1G 8PH, UK.
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Xubias 84, Coruña 15006, Spain
| | - Joachim Schmidt
- Department of Thoracic Surgery, Malteser Hospital, Von-Hompesch-Strasse 1, Bonn 53123, Germany
| | - Benedetta Bedetti
- Department of Thoracic Surgery, Malteser Hospital, Von-Hompesch-Strasse 1, Bonn 53123, Germany
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Miyazawa M, Aikawa M, Okada K, Watanabe Y, Okamoto K, Koyama I. Laparoscopic liver resection using a monopolar soft-coagulation device to provide maximum intraoperative bleeding control for the treatment of hepatocellular carcinoma. Surg Endosc 2018; 32:2157-8. [PMID: 28916868 DOI: 10.1007/s00464-017-5829-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/17/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND The popularity of laparoscopic liver resection (LLR) is spreading, worldwide, because the intraoperative blood loss is less than for open hepatectomy and it is associated with a shorter hospitalization period [1-6]. During LLR, intraoperative hemostasis is difficult to achieve, unlike during laparotomy where bleeding can be stopped instantly [7-10]. Our LLR method for the treatment of hepatocellular carcinoma (HCC) includes maximal control of intraoperative bleeding using a monopolar soft-coagulation device. Although we use a monopolar soft-coagulation device to control bleeding during LLR, while coagulating the thin blood vessels, we also developed a maneuver (the hepatocyte crush method: HeCM) to allow liver transection to progress while liver parenchymal cells are being crushed. METHOD Between January 2008 and March 2016, we performed total LLR on 150 hepatocellular carcinoma patients (144 partial liver resections and six left lateral sectionectomies) using the maneuver shown in the video. RESULTS The patients had Child-Pugh Scores of grade A (n = 100), B (42), or C (n = 8) and the localizations of tumor were segment (S) 1(n = 7), S2 (19), S3 (23), S4 (28), S5 (17), S6 (26), S8 (17), and S8 (29). The median blood loss was 30 (range 0-490) g during a median surgical time of 207 (range 127-468) min. One patient required conversion to a laparotomy due to the presence of severe adhesions; none of the patients required conversion due to intraoperative hemorrhage. The peak aspartate aminotransferase (AST) level was 320 (range 57-1964) IU/L. Although some patients showed high AST levels, none showed signs of hepatic failure. The median postoperative hospital stay duration was 6 (range 3-21) days. Postoperative complications occurred in seven cases (4.7%), including intraabdominal abscesses (n = 2), wound infections (2), intraabdominal hemorrhage (1), bile duct stricture (1), and umbilical hernia (1). The mortality was zero. CONCLUSION HeCM, combined with the use of a monopolar soft-coagulation device, is a good technique for reducing bleeding during liver resection in patients with HCC.
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Ozkose M, Baykan H, Coşkuner İ. The Effect of Patient Positioning on Amount of Intraoperative Bleeding in Rhinoplasty: A Randomized Controlled Trial. Aesthetic Plast Surg 2016; 40:453-7. [PMID: 27225876 DOI: 10.1007/s00266-016-0653-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/05/2016] [Indexed: 01/09/2023]
Abstract
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 .
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Soylu E, Kersin B, Karaaslan P, Çalım ÖF, Altın G, Tercan E. Effect of anesthesia without a neuromuscular blocking agent on intraoperative bleeding in adenotonsillectomy patients. Int J Pediatr Otorhinolaryngol 2015; 79:909-911. [PMID: 25899322 DOI: 10.1016/j.ijporl.2015.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effect of general anesthesia, applied without a neuromuscular blocking agent, on the extent of intraoperative bleeding in children undergoing adenotonsillectomy. MATERIALS AND METHODS A total of 81 adenotonsillectomy cases were examined retrospectively. The patients' ages, genders, and tonsil and adenoid sizes, as well as anesthetic technique, operation time, extent of bleeding during operation, and period of stay in the postanesthesia care unit, were reviewed. Among the patients, 38 were administered anesthesia with a neuromuscular blocker (control group) and 43 patients were given anesthesia without a neuromuscular blocker (study group). RESULTS No statistically significant difference was found between groups in terms of age, gender, and tonsil and adenoid sizes (p > 0.05). The operation times of the study group were significantly lower than those of the control group (p = 0.036; p < 0.05). A highly statistically significant difference was found between groups in terms of extent of bleeding (p = 0.001; p < 0.01). Bleeding in the study group was significantly lower than that in the control group. No statistically significant difference was found in terms of period of stay in the post anesthesia care unit (p > 0.05). CONCLUSION In this study, we determined that, general anesthesia without a neuromuscular blocking agent significantly decreases operation time and intraoperative bleeding in adenotonsillectomy patients.
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Affiliation(s)
- Erkan Soylu
- Department of Otolaryngology, Head and Neck Surgery, Medipol University Hospital, İstanbul, Turkey.
| | - Burak Kersin
- Department of Otolaryngology, Head and Neck Surgery, Medipol University Hospital, İstanbul, Turkey
| | - Pelin Karaaslan
- Department of Anesthesiology, Medipol University Hospital, İstanbul, Turkey
| | - Ömer Faruk Çalım
- Department of Otolaryngology, Head and Neck Surgery, Medipol University Hospital, İstanbul, Turkey
| | - Gökhan Altın
- Department of Otolaryngology, Head and Neck Surgery, Medipol University Hospital, İstanbul, Turkey
| | - Elvan Tercan
- Department of Anesthesiology, Medipol University Hospital, İstanbul, Turkey
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Hadavi MR, Zarei Y, Tarogh S. Comparison of effects of labetalol and nitroglycerine on intraoperative blood loss and surgical field quality in rhinoplasty surgery. World J Plast Surg 2015; 4:60-5. [PMID: 25606478 PMCID: PMC4298866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/20/2014] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Rhinoplasty is one of the most common surgeries of the plastic surgery and as well as ear, throat and nose. Intra-operative bleeding during surgery is one of the most important factors that may impair the surgeon's job. Providing a clean blood-free surgical filed makes the operation faster, easier and with a better quality. One way to achieve this goal is to induce hypotension. This study aimed to compare the impacts and outcomes of administration of labetalol or nitroglycerin for this purpose. METHODS In this randomized clinical trial, 60 ASA I and ASA II patients who were referred for rhinoplasty were enrolled. Patients were randomly assigned to two groups. Labetalol was given to the first and nitroglycerin to the second group of patients. Blood pressure and the amount of intra-operative bleeding during surgery and surgeon satisfaction were measured. RESULTS The average age of patients was 25.9±7.52 years. The average amount of bleeding among all patients was 117.87±324.86 ml, and the average quality of the surgical site was 1.65±4.48, considering all patients. The average quality and average surgical site bleeding between the two groups was not significant. CONCLUSION There was a little difference between labetalol and nitroglycerine on the effect of intraoperative blood loss and surgical field quality in rhinoplasty surgery.
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Affiliation(s)
| | - Yadollah Zarei
- Correspondence Author: Yadollah Zarei, MD; Department of Anesthesiology and Intensive Care, Shiraz University of Medical Sciences, Shiraz, Iran, Tel: +98-71-32357282, E-mail:
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Sieśkiewicz A, Reszeć J, Piszczatowski B, Olszewska E, Klimiuk PA, Chyczewski L, Rogowski M. Intraoperative bleeding during endoscopic sinus surgery and microvascular density of the nasal mucosa. Adv Med Sci 2014; 59:132-5. [PMID: 24797989 DOI: 10.1016/j.advms.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 10/24/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the correlation between quality of the surgical field, intraoperative bleeding during endoscopic sinus surgery (ESS) and the density of microvasculature of the nasal mucosa. MATERIAL/METHODS Nasal mucosa of 30 patients, operated for chronic rhinosinusitis, was biopsied to assess expression of CD34 antigen on vascular endothelium. Quality of surgical field was evaluated with Fromm-Boezaart scale at mean arterial pressure (MAP) of 70-80 mmHg. If at this MAP surgical field quality was not satisfactory further reduction of hemodynamic parameters was performed until 'bloodless surgical field' (grade 2 or lower) was achieved. The rate of intraoperative bleeding was calculated from the ratio of total blood loss and the operative time. The extent of the disease was assessed according to computed tomography findings using Lund-Mackay staging system. RESULTS Significant positive correlation (Spearman correlation test; p<0.05) was found between CD34 antigen expression and quality of surgical field at MAP between 70 and 80 mmHg as well as the rate of intraoperative bleeding. More intense reduction of MAP was necessary to achieve 'bloodless surgical field' in patients with high CD34 expression than in those with moderate and low expression. Lund-Mackay score correlated with quality of surgical field but not with the rate of intraoperative bleeding. CONCLUSION During ESS, it is microvascular density of the nasal mucosa rather than the extent of the disease that contributes to the intensity of intraoperative bleeding, although both factors negatively influence the quality of surgical field.
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Affiliation(s)
- Andrzej Sieśkiewicz
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
| | - Joanna Reszeć
- Department of Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | | | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | | | - Lech Chyczewski
- Department of Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
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Nooraei N, Dabbagh A, Niazi F, Mohammadi S, Mohajerani SA, Radmand G, Hashemian SMR. The Impact of Reverse Trendelenburg Versus Head-up Position on Intraoperative Bleeding of Elective Rhinoplasty. Int J Prev Med 2013; 4:1438-41. [PMID: 24498500 PMCID: PMC3898450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 09/13/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. OBJECTIVE In this study, we aimed to compare reverse trendelenburg position and head-up position on intra-operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. METHODS In this study, 30 ASA I (American Society of Anesthesiology physical condition classification) patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head-up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. RESULTS Our results showed that the mean amount of blood loss in reverse trendelenburg was lower (77.00 ± 13.20 ml) than head-up position (83.33 ± 21.18 ml), although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. CONCLUSIONS Our results showed that patient bleeding is not increased because of positioning per se. In conclusion, perhaps in the future reverse trendelenburg will be given more often during rhinoplasry.
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Affiliation(s)
- Navid Nooraei
- Anesthesiology Research Center, Department of Anesthesiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Dabbagh
- Anesthesiology Research Center, Department of Anesthesiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Feizolah Niazi
- Chronic Respiratory Disease Research Center (CRDRC), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran,Correspondence to: Prof. Feizolah Niazi, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
| | - Siamak Mohammadi
- Chronic Respiratory Disease Research Center (CRDRC), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Seyed Amir Mohajerani
- Anesthesiology Research Center, Department of Anesthesiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnar Radmand
- Chronic Respiratory Disease Research Center (CRDRC), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Disease Research Center (CRDRC), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
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Paolo F, Marialuisa B, Stefania B, Helmut G, Moira M, Cristiana C, Carlo O. Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation. World J Hepatol 2013; 5:1-15. [PMID: 23383361 PMCID: PMC3562721 DOI: 10.4254/wjh.v5.i1.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 01/19/2013] [Indexed: 02/06/2023] Open
Abstract
Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system, portal hypertension with multiple collateral vessels, portal vein thrombosis, previous abdominal surgery, splenomegaly, and poor “functional” recovery of the new liver. The intrinsic coagulopathic features of end stage cirrhosis along with surgical technical difficulties make transfusion-free liver transplantation a major challenge, and, despite the improvements in understanding of intraoperative coagulation profiles and strategies to control blood loss, the requirements for blood or blood products remains high. The impact of blood transfusion has been shown to be significant and independent of other well-known predictors of posttransplant-outcome. Negative effects on immunomodulation and an increased risk of postoperative complications and mortality have been repeatedly demonstrated. Isovolemic hemodilution, the extensive utilization of thromboelastogram and the use of autotransfusion devices are among the commonly adopted procedures to limit the amount of blood transfusion. The use of intraoperative blood salvage and autologous blood transfusion should still be considered an important method to reduce the need for allogenic blood and the associated complications. In this article we report on the common preoperative and intraoperative factors contributing to blood loss, intraoperative transfusion practices, anesthesiologic and surgical strategies to prevent blood loss, and on intraoperative blood salvaging techniques and autologous blood transfusion. Even though the advances in surgical technique and anesthetic management, as well as a better understanding of the risk factors, have resulted in a steady decrease in intraoperative bleeding, most patients still bleed extensively. Blood transfusion therapy is still a critical feature during OLTx and various studies have shown a large variability in the use of blood products among different centers and even among individual anesthesiologists within the same center. Unfortunately, despite the large number of OLTx performed each year, there is still paucity of large randomized, multicentre, and controlled studies which indicate how to prevent bleeding, the transfusion needs and thresholds, and the “evidence based” perioperative strategies to reduce the amount of transfusion.
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Abstract
AIM: To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC).
METHODS: Fifty-nine patients with HCC were divided into 3 groups based on the technique used for achieving hepatic vascular occlusion: group 1, vascular occlusion was achieved by the Pringle maneuver (n = 20); group 2, by hemihepatic vascular occlusion (HVO) (n = 20); and group 3, by BIOwHAC (n = 19). We compared the procedures among the three groups in term of operation time, intraoperative bleeding, postoperative liver function, postoperative complications, and length of hospital stay.
RESULTS: There were no statistically significant differences (P > 0.05) in age, sex, pathological diagnosis, preoperative Child’s disease grade, hepatic function, and tumor size among the three groups. No intraoperative complications or deaths occurrred, and there were no significant intergroup differences (P > 0.05) in intraoperative bleeding, hepatic function change 3 and 7 d after operation, the incidence of complications, and length of hospital stay. BIOwHAC and Pringle maneuver required a significantly shorter operation time than HVO; the difference in the serum alanine aminotransferase or aspartate aminotransferase levels before and 1 d after operation was more significant in the BIOwHAC and HVO groups than in the Pringle maneuver group (P < 0.05).
CONCLUSION: BIOwHAC is convenient and safe; this technique causes slight hepatic ischemia-reperfusion injury similar to HVO.
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