scholarly journals Acute hypervolemic hemodilution combined with controlled hypotension to minimize blood loss during operations of spine fusion: remifentanil versus magnesium sulfate

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Khaled Mohammed Elnaghy ◽  
Ibrahimabd-Elsalam Nasr ◽  
Eman Mohamed Kamal
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Magnesium Sulfate ◽  
Spine Fusion ◽  
Controlled Hypotension ◽  
Group Iii ◽  
Group I ◽  
Estimated Blood Loss ◽  
Hypervolemic Hemodilution ◽  
Group Ii

Abstract Background Blood loss is one of the major problems during operations of spine fusion. Several blood-conservative measures were applied to reduce the incidence of blood loss—among them, acute hypervolemic hemodilution (AHH) and controlled hypotension (CH). This study was designed to detect the effect of combination of AHH with CH induced by remifentanil versus magnesium sulfate on the volume of blood loss, allogeneic blood transfusion, hemodynamics, coagulation, and electrolytes during operations for spine fusion which are risky operations with high incidence of blood loss and blood transfusion. Sixty patients scheduled for posterior fusion of the spine were randomly allocated into three groups of 20 patients each (group I (AHH), group II (AHH combined with remifentanil-based CH), and group III (AHH combined with magnesium sulfate-based CH)). Estimated blood loss and total volume of packed red blood cells (PRBCS) transfused were recorded. Arterial blood pressure (ABP) and heart rate (HR) measures were recorded. Blood samples were obtained for the detection of hemoglobin (Hb) and hematocrit (HCT). Results Estimated blood loss, percentage blood loss, and intraoperative RBC transfusion units were significantly high in group I in relation to group II and group III (Table 2). Cardiac output was significantly higher in group I in relation to group II and group III at 10, 15, 30, 45, and 60 min after start of AHH. MBP and HR results were significantly high in group I in comparison with group II and group III at 30, 45, 60, and 90 min and 2 and 3 h after start of study drugs. CVP results were significantly high in group I in relation to group II and group III at 15, 30, 45, 60, and 90 min after start of AHH. PTT was significantly increased in the three study groups in comparison with baseline inside each group after AHH. Conclusion Combination of AHH with CH induced by remifentanil or magnesium sulfate was associated with reduction in estimated blood loss, and total volume of PRBCS transfused. There was no significant difference between hemodynamic parameters with the use of remifentanil or magnesium sulfate except that SBP, DBP, and MBP results were significantly high with magnesium sulfate at 15 min after drug infusion. There was significant increase in PT and PTT after AHH that was not reflected by significant blood oozing from the operative field, or by difficulty in hemostasis.

scholarly journals A comparative study between the efficacy of local intra-myometrial injection of vasopressin and octreotide acetate, in reducing blood loss during myomectomy

2017 ◽  
Vol 6 (10) ◽  
pp. 4230
Author(s):  
Amira Mohammed Badawy
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Operative Time ◽  
Pressure Effects ◽  
Control Group ◽  
Group Iii ◽  
Abdominal Myomectomy ◽  
Octreotide Acetate ◽  
Group I ◽  
Group Ii

Background: Symptomatic Uterine leiomyomata may lead to many symptoms including abnormal uterine bleeding, mass pressure effects and infertility. Myomectomy is an option for conservative management, however, it is associated with some disadvantages, mainly increased intra-operative blood loss. Intra-myometrial vasopressin injection during myomectomy is an effective method to decrease the intraoperative bleeding due to its vasoconstrictor effect. Octreotide Acetate (OA) is another vasoconstrictor agent that have not been tested for gynaecologic indications. The current study was conducted to assess the efficacy of local injection of OA in reducing blood loss during conventional abdominal myomectomy, and to compare it with local instillation of vasopressin.Methods: 60 cases with symptomatic leiomyomata were recruited and planned for abdominal myomectomy, they were divided randomly into 3 groups, 20 cases in each. Group I, where local vasopressin was used, group II, where OA was used, and group III (the control group), where no specific medication was used and only free Saline was injected locally.Results: The overall results showed that OA group had significantly less operative time and less blood loss compared to control group. However, when compared to cases in group I, operative time and blood loss were significantly higher. Postoperative haemoglobin levels were significantly lower in group III compared to groups I (P = 0.039) and II (P = 0.044). Blood transfusion was indicated in 9 cases among group III, while only one case needed blood transfusion in group II, and no cases in group I.Conclusions: The use of local intra-myometrial OA is an option for reducing blood loss during myomectomy, but still efficacy is less than local vasopressin. This may be attributed to the low concentrations used, and to the less potency of OA as a vasoconstrictor agent.

Impact of an Autotransfusion System during Endoluminal Repair of Abdominal Aortic Aneurysms: Does it Decrease the use of Allogeneic Blood?

2005 ◽  
Vol 71 (9) ◽  
pp. 786-790
Author(s):  
Carlos Donayre ◽  
Uzoamaka Adimora ◽  
Tae Song ◽  
George Kopchok ◽  
Maurice Lippmann ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Abdominal Aortic Aneurysms ◽  
Group Iv ◽  
Aortic Aneurysms ◽  
Group Iii ◽  
Endoluminal Repair ◽  
Group I ◽  
Abdominal Aortic ◽  
Group Ii

Endoluminal repair of abdominal aortic aneurysms (AAA) is associated with decreased blood loss and transfusion requirements when compared to open AAA repair. We evaluated the use of an intraoperative autotransfusion system during endoluminal exclusion of AAAs. Fifty endoluminal AAA procedures selected at random were reviewed retrospectively. Patients were divided into 4 groups according to their estimated blood loss: Group I, 20 patients (0–500 cc); Group II, 18 patients (501–1,000 cc); Group III, 7 patients (1,001–1,500 cc); and Group IV, 5 patients (1,501–3,400 cc). The average blood loss was 327 cc for Group I, 728 cc for Group II, 1,217 for Group III, and 2,125, for Group IV. The overall blood loss was 834 cc, but 75 per cent was recovered. Hematuria was always present when greater than 1,000 cc of blood was retransfused, but renal function was not affected even with the concomitant administration of radiographic contrast. Only one patient required an autologous blood transfusion. The use of an autotransfusion device is safe, efficacious, and appears to further limit the need for homologous blood transfusion in patients undergoing endoluminal AAA repair.

scholarly journals Adjunctive intrauterine Foley’s Catheter Balloon adding to hypogastric artery ligation in the conservative management of morbid adherent placenta previa

2018 ◽  
Vol 7 (6) ◽  
pp. 2093
Author(s):  
Hany F. Sallam ◽  
Nahla W. Shady
Keyword(s):  
Blood Loss ◽  
Placenta Previa ◽  
Hypogastric Artery ◽  
Artery Ligation ◽  
Cesarean Hysterectomy ◽  
Adherent Placenta ◽  
Group I ◽  
Estimated Blood Loss ◽  
Group Ii ◽  
Foley’S Catheter

Background: Objective of present study was to demonstrate the efficacy of Foley’s catheters balloon tamponade as an adjuvant to control blood loss during and after a caesarian section in patient undergone hypogastric artery ligation (HAL) due to morbid adherent placenta previa (MAPP).Methods: A single-center retrospective case-control clinical trial was carried out in a tertiary university hospital between March 2015 and March 2018, 124 women were undergoing cesarean delivery for MAPP, were managed conservatively either with HAL or HAL plus inflated Intrauterine Foley’s Catheter Balloon to control post-partum hemorrhage secondary to MAPP. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed.Results: 124 women were enrolled (n=62 in each group). group of women received HAL plus Intrauterine Foley’s Catheter Balloon (group II)) showed a significant reduction in intraoperative and 4 hours post-operative blood loss compared with (Group I) which received HAL without Intrauterine Foley’s Catheter Balloon. (P = 0.0001,0.0.015), so the overall estimated blood loss in group II showed significant reduction compared with group I (P = 0.0001).Conclusions: Adjunctive intrauterine Foley's catheter balloon adding to HAL ligation in the management of MAPP is a novel combination approach have proved to be effective to control of intraoperative and PPH and to preserve the uterus as possible and change in the concept of MAPP management always mandates hysterectomy. And may become an alternative valid option to planned cesarean-hysterectomy in well-selected cases who have a strong desire for future fertility.

scholarly journals Efficacy of Preoperative Misoprostal in Reducing Hemorrhage during Abdominal Myomectomy

2021 ◽  
Vol 15 (6) ◽  
pp. 1934-1936
Author(s):  
Irum Batool Hashmi ◽  
Asim Shafi ◽  
Ayesha Choudhary ◽  
Wasim Ahmad ◽  
Muhammad Hamayun Khan ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Body Mass ◽  
Intraoperative Blood Loss ◽  
Abdominal Myomectomy ◽  
Group I ◽  
Group Ii ◽  
One Year ◽  
Double Blinded

Objective: The aim of this study is to determine the efficacy of preoperative misoprostal in reducing hemorrhage during abdominal myomectomy. Study Design: Prospective comparative randomized double blinded Place and Duration: Conducted at DHQ Zanana hospital Dera Ismail Khan for one year duration from January 2019 to December 2019. Methods: Total 100 patients underwent abdominal myomectomy were presented in this study. Patients were aged between 18-45 years of age. Patients’ detailed demographics including age, body mass index and parity were recorded after taking informed written consent. Patients were categorized equally into two groups, I and II. Group I had 50 patients and received single dose 400 micrograms of misoprostol transrectally one hour preoperatively and group II had 50 patients and received 2-tablets of placebo preoperatively. Outcomes intraoperative blood loss, blood transfusion, hysterectomy and complications among both groups were assessed. Complete data was analyzed by SPSS 23.0 version. Results: Mean age of the patients was 32.16±9.44 with mean BMI 26.07±10.44 kg/m2. There were no significantly difference among age and body mass among both groups. 60 Patients had 0 parity, 30 patients had parity 1 and the rest were had parity 2. Mean pre-operative hemoglobin in group I was 13.64±8.55 and post-operative was 9.88±8.55 and in group II mean pre-operative hemoglobin was 13.55±8.55 and post-operative was 9.12±5.55. Mean intraoperative blood loss in group I was 388.17±37.18 ml and in group II was 501.16±17.64 ml. Post-operatively blood transfusion in group I was among 2(4%) cases and 3 (6%) in group II. Mean hospital stay in group II was greater as compared to group I. Nausea, vomiting and shivering were the complications found in this study. Conclusion: We concluded in this study that the use ofmisoprostol preoperatively during abdominal myomectomy was effective safe and useful in reduction of intraoperative blood loss and post-operatively blood transfusion among patients. Keywords: Abdominal myomectomy, Misoprostol, Placebo, Intraoperative, Blood loss

scholarly journals TAMPANG JENUH TRANSFERIN PENDONOR DARAH ANEMIA

2018 ◽  
Vol 15 (3) ◽  
pp. 78
Author(s):  
Christina Roosarjani ◽  
Titis Wahyuono ◽  
J B Suparyatmo
Keyword(s):  
Blood Transfusion ◽  
Blood Donors ◽  
Blood Donation ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Red Cross ◽  
Blood Donations ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Iron deficiency remains one of the most frequent adverse effects of blood donation. Iron status test used on blood donor screeningis haemoglobin concentration. Other iron status parameters are transferrin saturation. The study aims to determine the profile oftransferrin saturation among certain groups of blood donors at the Blood Transfusion Unit of the Indonesian Red Cross SurakartaBranch. The samples were drawn from blood donors at the Blood Transfusion Unit from June to December 2005. A total of 148 specimenswere classified into 3 groups consist of 49 first time blood donations as group I, 50 of fifth time blood donations as group II, and 49of tenth time blood donations as group III. Transferrin saturation was measured by ratio between serum iron and Total Iron BindingCapacity (TIBC). The data analysed by Anova test to distinguish the difference of transferrin saturation among three groups. The resultsshowed the transferrin saturation decreased from group I to group II and from group II to group III. The transferrin saturation amongthree groups showed significantly difference (p=0.000). It can be concluded that there is a decrease in transferrin saturation accordingto the blood donation frequency among blood donors at the Blood Transfusion Unit of the Indonesian Red Cross Surakarta Branch.Transferrin saturation measurement is needed for another parameter of iron deficiency anaemia among blood donors.

Kinetics of erythropoiesis. A comparison of response to anemia induced by phenylhydrazine and by blood loss

1959 ◽  
Vol 197 (4) ◽  
pp. 761-764 ◽  
Author(s):  
Clement A. Finch ◽  
Mary Lu Hanson ◽  
Dennis M. Donohue
Keyword(s):  
Blood Loss ◽  
Normal Animal ◽  
Red Cell ◽  
Group Iii ◽  
Quantitative Measurements ◽  
Group I ◽  
Group Ii ◽  
Kinetics Of ◽  
Removal Group ◽  
Made In

Quantitative measurements of the erythron were made in rabbits. Anemia was produced by red cell removal ( group I), hemolysis from phenylhydrazine ( group II) and red cell removal with replacement by nonviable erythrocytes ( group III). Young red cells, including nucleated and reticulated cell forms, totaled 1.67 x 1010 cells in the normal animal. In anemic animals, by the 3rd day this had increased to 3.59 x 1010 ( group I) and 3.68 ( group II). By the 6th day, average values were 7.24 ( group I) and 7.1 ( group II). There was a greater proportion of young cells in the nucleated form in group I as compared with group II. The addition of nonviable cells ( group III) did not augment erythropoiesis in bled animals. A reticulocyte shift from marrow to circulating blood, proportionate to the degree of anemia, was observed. These studies indicate an augmentation of the rate of erythropoiesis to about three times normal. There was no evidence that products of red cell destruction influence the rate of erythropoiesis.

scholarly journals POST PARTUM HAEMORRHAGE PROPHYLAXIS

2008 ◽  
Vol 15 (03) ◽  
pp. 323-327
Author(s):  
ALIYA ISLAM ◽  
ASIFA SIRAJ ◽  
NADIA ARIF
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Post Partum ◽  
Military Hospital ◽  
Standard Size ◽  
Group I ◽  
Significant Difference ◽  
Post Partum Haemorrhage ◽  
Group Ii ◽  
Group 2

Post partum hemorrhage (PPH) is defined as the loss of greater than 500ml of blood from the genitaltract in the first 24 hours following delivery. PPH occurs in 2-11% of all deliveries. Objective: To compare the efficacyof misoprostol and ergometrine for the prophylaxis of Post Partum Haemorrhage. Design: Prospective study. Setting:Gynaecology and Obstetrics Department Military Hospital Rawalpindi. Period: From 01 July 2006 to 31 Dec 2006.Patients & Methods: A total of 200 patients were recruited in the study, they were divided in two groups, group – I (n100) included those patients who were administered ergometrine intravenously at the time of delivery of head for theprophylaxis of post partum haemorrhage, Group – 2 (n-100) included those patients who were administered Misoprostol800 microgram per rectally just before the start of cesarean section for the same purpose. Blood loss was calculatedobjectively by squeezing the soaked pads and quantifying the amount of clots in a kidney tray of standard size to beequal to 500ml.Results: In group I (n-100) 15 patients had mild PPH blood loss >500ml, out of them 03 had severePPH requiring bimanual message and 02 patients required blood transfusion, in group II( n-100). 08 patients had PPH,blood loss >500 ml, out of them 01 patient required uterine message and none required blood transfusion. Chi-squaretest was applied to compare the efficacy of the two groups, P>0.05 showed no significant difference in the efficacy ofthe two groups but the side effects were obviously less in the Misoprostol group. No patient in group II had GI symptomswhile 36 patient in group I had retching and, vomiting and 03 patients had raised B.P after the administration ofergometrine. Conclusion: Misoprostol administered per rectally has equal efficacy to ergometrine given intravenouslyfor the prophylaxis of post partum haemorrhage but the side effect profile and patient tolerability is better withMisoprostol.

scholarly journals Dose Response Study of Magnesium Sulphate for Attenuation of Haemodynamic Response to Intubation

2021 ◽  
Vol 10 (13) ◽  
pp. 956-961
Author(s):  
Sarita Nandal ◽  
Veena Chatrath ◽  
Harjinder Kaur ◽  
Reeta Reeta
Keyword(s):  
Sample Size ◽  
Magnesium Sulfate ◽  
Endotracheal Intubation ◽  
Magnesium Sulphate ◽  
Serum Magnesium ◽  
Haemodynamic Response ◽  
Hypertensive Patients ◽  
Group Iii ◽  
Group I ◽  
Group Ii

BACKGROUND Effects of pretreatment with magnesium sulphate for attenuation of haemodynamic response to intubation have been studied previously but its effects on hypertensive patients are not much studied. This study was conducted primarily to find the minimal effective dose of magnesium sulphate to control the haemodynamic response to laryngoscopy and endotracheal intubation in controlled hypertensive patients. METHODS After institutional ethical committee clearance, a randomised, double blinded, clinical study was carried out among 90 American Society of Anaesthesiologists (ASA) physical status II, controlled hypertensive patients of age 30 - 60 years posted for elective surgery. Patients were randomly distributed into three equal groups as group I - received 30 mg / Kg magnesium sulfate and group II - received 40 mg / Kg magnesium sulfate before induction of anesthesia, while group III (control group) received 1.5 mg / Kg lidocaine bolus 90 seconds prior to intubation. The patients’ haemodynamic responses were noted before, during, and after intubation for 10 minutes. Steps taken to manage haemodynamic instability along with serum magnesium levels were also noted. To calculate the sample size, mean value of serum magnesium was taken in three groups to find out effect size as 0.0387. Taking alpha error 0.05 and power required 90 %, the sample size in each group was 30. RESULTS Groups were properly matched for their demographic data. Among all the groups changes in heart rate were comparable (P > 0.05) throughout the study period. In group I there was no significant change in mean arterial pressure (MAP) while in group II and group III a significant decrease was noticed (> 20 % of baseline value). Intervention was required to treat hypotension in significant number of patients in group II (nine patients) and group III (three patients). CONCLUSIONS In controlled hypertensive patients, magnesium in a dose of 30 mg / Kg intravenous is found optimal to attenuate the stress response following laryngoscopy and endotracheal intubation, as further increase in dose can lead to significant hypotension. KEY WORDS Hypertension, Laryngoscopy, Lignocaine, Magnesium Sulphate, Intubation

scholarly journals Effect of intravenous tranexamic acid on blood loss and blood transfusion in total knee replacement: a prospective, randomized study in Indian population

2017 ◽  
Vol 3 (5) ◽  
pp. 916
Author(s):  
Shivakumar Kerakkanavar ◽  
Raghavendra Venkatesh ◽  
K. M. Gopinath ◽  
Pramodkumar M.
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Primary Total Knee Replacement ◽  
Group I ◽  
Total Knee ◽  
Group Ii ◽  
Primary Total Knee

<p class="abstract"><strong>Background:</strong> Tranexamic acid (TXA) is antifibrinolytic drug which has the property to reduce intraoperative and postoperative bleeding. There are several studies supporting the use of tranexamic acid in total knee replacements (TKR) and few in total hip replacements. Our study was intended to establish the effects of tranexamic acid in minimizing the intra operative and post-operative blood loss in uncomplicated primary total knee replacement.</p><p class="abstract"><strong>Methods:</strong> This was a prospective follow up study conducted in Rajarajeshwari Medical College and Hospital Bangalore, over a period of 14 months from June 2015 to August 2016. A total number of 60 patients who underwent unilateral primary total knee replacement were included for this study. They were randomly divided into 2 groups. Group I patients infused (intravenous) with 20 mg/kg TXA before incision and 3 hours after surgery whereas no TXA was administered in Group II. Total blood loss and transfusion rate were used as outcome. <strong></strong></p><p class="abstract"><strong>Results:</strong> Mean amounts of blood loss were 578 ml in Group 1 and 946 ml in Group 2. There was a decrease in blood loss in TXA groups (p&lt;0.001). Transfusion was required in 6 patients of Group I and 17 patients of Group II (p&lt;0.001). No thromboembolic problem was seen in any patients.</p><p><strong>Conclusions:</strong> Since TXA decrease perioperative blood loss and lessen the need for blood transfusion significantly, without increasing thromboembolic events in TKR. We suggest using intravenous (IV) TXA in TKR. </p>

Ultrastructural Lesions Produced by Alcohol and Sucrose in the Heart and Liver of C57BL Mice

1970 ◽  
Vol 28 ◽  
pp. 208-209
Author(s):  
K.K. SEKHRI ◽  
C.S. ALEXANDER ◽  
H.T. NAGASAWA
Keyword(s):  
Osmium Tetroxide ◽  
Male Mice ◽  
Alcohol Group ◽  
Group Iii ◽  
Group I ◽  
C57bl Mice ◽  
Group Ii

C57BL male mice (Jackson Lab., Bar Harbor, Maine) weighing about 18 gms were randomly divided into three groups: group I was fed sweetened liquid alcohol diet (modified Schenkl) in which 36% of the calories were derived from alcohol; group II was maintained on a similar diet but alcohol was isocalorically substituted by sucrose; group III was fed regular mouse chow ad lib for five months. Liver and heart tissues were fixed in 2.5% cacodylate buffered glutaraldehyde, post-fixed in 2% osmium tetroxide and embedded in Epon-araldite.

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