Preoperative Particle and Glue Embolization of Meningiomas: Indications, Results, and Lessons Learned from 117 Consecutive Patients

2013 ◽  
Vol 73 (2) ◽  
pp. ons244-ons252 ◽  
Author(s):  
Anouk Borg ◽  
Jinendra Ekanayake ◽  
Richard Mair ◽  
Thomas Smedley ◽  
Stefan Brew ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Transfusion Requirement ◽  
Lessons Learned ◽  
Direct Result ◽  
Embolic Agent ◽  
Operative Blood Loss ◽  
Indirect Measure ◽  
Blood Transfusion Requirement ◽  
Transfusion Requirements

Abstract BACKGROUND: Preoperative embolization of meningiomas remains contentious, with persisting uncertainty over the safety and efficacy of this adjunctive technique. OBJECTIVE: To evaluate the safety of presurgical embolization of meningiomas and its impact on subsequent transfusion requirement with respect to the extent of embolization and technique used. METHODS: One hundred seventeen consecutive patients between 2001 and 2010 were referred for embolization of presumed intracranial meningioma before surgical resection. Glue and/or particles were used to devascularize the tumor in 107 patients, all of whom went on to operative resection. The extent and nature of embolization-related complications, degree of angiographic devascularization, and the intraoperative blood transfusion requirements were analyzed. RESULTS: Mean blood transfusion requirement during surgery was 0.8 units per case (range, 1-14 units). Blood transfusion was significantly lower in patients whose meningiomas were completely, angiographically devascularized (P = .035). Four patients had complications as a direct result of the embolization procedure. These included intratumoral hemorrhage in 2, sixth cranial nerve palsy in 1, and scalp necrosis requiring reconstructive surgery in 1 patient. CONCLUSION: The complication rate was 3.7%. No relationship between the embolic agent and the degree of devascularization was observed. Achieving a complete devascularization resulted in a lower blood transfusion requirement, considered an indirect measure of operative blood loss. This series demonstrates that preoperative meningioma embolization is safe and may reduce operative blood loss. We present distal intratumoral injection of liquid embolic as a safe and effective alternative to more established particle embolization techniques.

The Role of Iron Chelation Activity of Wheat Grass Juice in Blood Transfusion Requirement of Intermediate Thalassaemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3829-3829
Author(s):  
Soma Mukhopadhyay ◽  
Ashis Mukhopadhyay ◽  
Pinaki Ranjan Gupta ◽  
Manoj Kar ◽  
Arpita Ghosh
Keyword(s):  
Blood Transfusion ◽  
Haemoglobin Level ◽  
Crude Extract ◽  
Transfusion Requirement ◽  
Ferritin Level ◽  
Performance Status ◽  
Iron Chelator ◽  
Blood Transfusion Requirement ◽  
Transfusion Requirements ◽  
The Mean

Abstract Background: Previously it was thought that the chlorophyll of wheat grass (Triticum astevum) may be the substitute of haemoglobin of RBC having resemblance of similar structure. A group of Austrelian scientists tried to prove that wheat grass juice increases the foetal haemoglobin level 3–5 folds in intermediate thalassaemia patients. A pilot study with wheat grass juice in major thalassaemia patients were done by Dr. Marwa et al in IPGMR, Chandigarh, India. But there is no satisfactory explanation behind the reduced blood transfusion requirements after consumption of wheat grass juice for a long period. The aim of our study was to see the effect of wheat grass juice in blood transfusion requirement in intermediate thalassaemia patients and also do the biochemical analysis of the wheat grass juice. Material & Methods: During period from January 2003 to December 2006 we selected 200 intermediate thalassaemia patients (E-thalassaemia, E-Beta & Sickle thal) in the paediatric oncology department of Netaji Subhash Chandra Bose Cancer Research Institute. The age range of the patients was 1 year to 35 years (median age 18 years). The different types of thalasssaemia were E-Beta Thalassaemia 80% (160 patients), E-Thalassaemia 15% (30 patients) and Sickle Thalassaemia 5% (10 patients). When the wheat grasses were 5–7 days old, the fresh leaves including steams were made fresh juice and had given 30ml of juice daily to all our 200 patients for continuous 6 months. Wheat grass juice was analysed by column chromatography and found to be rich in oxalic acid and malic acid which might have some role in dietary absorption of iron from intestine. Beside that the wheat grass juice was found to contain a unique iron chelating property which was performed by deoxyribose degradation assay. We compared aqueous soluble extract of 5–7th day plant and our dose dependant study showed a significant iron chelating activity of crude extract in comparison to known standard iron chelator desferroxamine (DFO). The active compounds of crude extract of wheat grass may chelate catalytic iron in iron overload disorders when taking systematic dose. Result: The mean levels of haemoglobin before starting wheat grass juice were 6.2gm%. After 6months of wheat grass therapy the mean value for haemoglobin was 7.8gm% (pvalue <. 005). Twenty four patients (12%) require blood transfusion (haemoglobin < 6gm%). The performance status was improved from 60% to 80% (Karnofsky) after wheat grass treatment. The ferritin level of all patients before the study was found to be decreased significantly after wheat grass juice consumption. The mean interval between transfusion were found increased. Being a natural potent iron chelator and H2O2 quencher, it prevents the hydroxyl radical production by Fenton reaction in the RBC. Thus it may prevent the breakdown of plasma membrane of RBC and haemoglobin level becomes stable for a prolonged period. Conclusion: We may conclude that wheat grass juice is an effective alternative of blood transfusion. It’s use in intermediate thalassaemia patients should be encouraged.

scholarly journals Preoperative Aspirin Use and Outcomes in Off-pump Coronary Artery Bypass Grafting Surgery

2018 ◽  
Vol 33 (1) ◽  
pp. 16-21
Author(s):  
Md Rezaul Karim ◽  
Tawfiq Ahmed ◽  
Rownak Khurshid ◽  
Shahriar Moinuddin ◽  
Md Kamrul Hasan
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Artery Bypass ◽  
Perioperative Period ◽  
Operative Blood Loss ◽  
Off Pump ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Pump Cabg ◽  
Group B

Introduction: Aspirin, the most widely used platelet function inhibitor extremely effective at blocking the production of thromboxane in platelets, rendering the platelets incapable of functioning normally, and thus preventing thrombosis. The practice of empirically discontinuing aspirin preoperatively should be abandoned because evidence strongly supports continued use of aspirin in patients for secondary prevention of CAD, CVD, or PVD when undergoing surgery.Methods and Materials: This Observational study was conducted at Department of Cardiac Surgery, NICVD, Dhaka, who underwent off pump CABG (OPCAB), divided in two groups, Group A: 24 patients who stopped and Group B: 24 patients who are continuing aspirin throughout the perioperative period. Post operative blood loss, requirement of blood transfusion, post-operative MI, ICU stay, Total hospital stay (days) and early post-operative complication (Stroke, New arrhythmia in ECG, 30 days mortality) were recorded and included in the study.Results: The key finding of the present study is that preoperatively continued aspirin use was not associated with increased risk of post-operative blood loss, blood transfusion requirements and need for re exploration after OPCAB.Conclusions: Preoperative aspirin therapy should be continued till off-pump CABG without interruption.Bangladesh Heart Journal 2018; 33(1) : 16-21

scholarly journals A randomized control trial to evaluate the effectiveness of intravenous, intra-articular and topical wash regimes of tranexamic acid in primary total knee arthroplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769352 ◽  
Author(s):  
Jatin Prakash ◽  
Jong-Keun Seon ◽  
Yong Jin Park ◽  
Cheng Jin ◽  
Eun-Kyoo Song
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Primary Total Knee Arthroplasty ◽  
Acid Group ◽  
Control Group ◽  
Operative Blood Loss ◽  
Mode Of Administration ◽  
Transfusion Requirements ◽  
Group 2

Background: The efficacy of tranexamic acid to decrease post-operative blood loss and blood transfusion is well established in literature. However, the ideal mode of administration is debatable. Limited literature has compared all the available modes of administration including intravenous (IV), topical irrigation and retrograde through drain. We hypothesized that no difference would be present in either form of administration of tranexamic acid. Methods: Fifty patients in four groups were enrolled for study. Group 1 received drug intravenously, group 2 had topical washing with drug before closure, group 3 received drug after closure through drain and group 4 was control that received no tranexamic acid. Post-operative blood loss, calculated blood loss, haemoglobin drop, transfusion requirements and complications were studied for all four groups. Results: Tranexamic acid results in lower bleeding irrespective of the mode of administration compared to control group. Total loss at end of 5 days is similar in all tranexamic acid groups irrespective of method used to deliver the drug. Calculated blood loss and haemoglobin drop was minimum for IV and in patients who were administered drug retrograde through drain. Requirement for blood transfusion was found to be lower in all tranexamic acid patients compared to non-tranexamic acid group. The requirement was highest in topical wash group among all tranexamic acid groups. Conclusion: We conclude that intra-articular administration through drain and IV administration are equally effective and superior to topical wash method in reducing blood loss, haemoglobin fall and transfusion requirements.

scholarly journals Haemodilution for Major Vascular Surgery — Using 3.5% Polygeline (Haemaccel)

1982 ◽  
Vol 10 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Michael J. Davies ◽  
Keith D. Cronin ◽  
Charles Domaingue
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Vascular Surgery ◽  
Operative Blood Loss ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
Blood Replacement ◽  
Transfusion Requirements ◽  
Major Vascular Surgery

Intra-operative haemodilution and autotransfusion was carried out in 32 patients having major vascular surgery. The intra-operative blood loss and peri-operative blood replacement was compared with that in 25 patients having similar surgery in whom haemodilution was considered to be contraindicated. Both groups of patients had similar mean intra-operative blood loss measured but homologous blood transfusion requirements were significantly different; 2.6 units (SD 1.9) in the haemodiluted patients compared with 6.0 units (SD 3.5) in the non-diluted patients. There was no mortality in the haemodiluted patients nor was any morbidity attributed to the procedure. Polygeline (haemaccel) was used as the diluent and proved satisfactory for this purpose.

scholarly journals A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

2018 ◽  
Vol 4 (4) ◽  
pp. 532 ◽  
Author(s):  
Sayyied J. Kirmani ◽  
Mark Middleton ◽  
Andreas Fontalis ◽  
Raka Srivastava ◽  
Feroz Dinah
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
The Body ◽  
Operative Blood Loss ◽  
Primary Total Knee Replacement ◽  
Transfusion Requirements ◽  
Total Knee ◽  
Primary Total Knee

<p class="abstract"><strong>Background:</strong> Primary total knee replacement (TKR) has traditionally been carried out with the use of a tourniquet. More recent trends towards performing the surgery without a tourniquet have had some support in the literature and may improve patient recovery.</p><p class="abstract"><strong>Methods:</strong> A retrospective cohort of 198 consecutive primary TKRs from our institution were identified and analysed, 52 used a tourniquet and 146 did not. All TKRs also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, topical adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion.<strong></strong></p><p class="abstract"><strong>Results:</strong> Analysis demonstrated a statistically significant reduction in estimated intra-operative blood loss when a tourniquet was used (p&lt;0.001). However, overall blood loss indicated by the haemoglobin drop after surgery was not significantly affected by tourniquet use (p=0.342). Transfusion requirements were also similar among the groups (4.8% vs. 5.8%) and no tendency was suggested towards an increased rate of transfusion in the non-tourniquet group.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows that although estimated intra-operative blood loss is increased without a tourniquet, total blood loss as measured by haemoglobin levels is no different for primary TKRs that use a tourniquet and those that do not. Furthermore there is no difference in post-operative blood transfusion rates. It is our hope that this study will add to the body of evidence for surgeons to consider no longer using a tourniquet for primary TKR.</p>

scholarly journals O42: THE ROLE OF TOURNIQUETS IN TRANSTIBIAL AMPUTATION FOR PERIPHERAL VASCULAR DISEASE: A SYSTEMATIC REVIEW & META-ANALYSIS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
D Cagney ◽  
J Byrne ◽  
GJ Fulton ◽  
BJ Manning ◽  
HP Redmond
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Revision Surgery ◽  
Lower Limb ◽  
Cochrane Library ◽  
Peripheral Vascular ◽  
Operative Blood Loss ◽  
Transfusion Requirements

Abstract Introduction The use of lower limb tourniquets is traditionally discouraged in severe atherosclerotic disease. However, blood loss and increased transfusion requirements are associated with post-operative morbidity in patients undergoing major lower limb amputation. The aim of this systematic review is to summarise and pool the available data to determine the impact of tourniquet application when performing trans-tibial amputation for peripheral vascular disease. Method This systematic review was conducted according to PRISMA guidelines. A systematic search of Medline, Embase and Cochrane Library was undertaken for articles which compared the use of a tourniquet versus no tourniquet in patients undergoing trans-tibial amputation for peripheral vascular disease. The main outcomes included intra-operative blood loss, post-operative transfusion requirement, need for revision surgery and 30-day mortality. Result Four studies met the inclusion criteria for quantitative analysis with a total of 267 patients. A tourniquet was used in 130 patients. Both groups were matched for age, gender, co-morbidities and pre-operative haemoglobin. In patients undergoing trans-tibial amputation, tourniquets were associated with significantly lower intra-operative blood loss (Mean difference= -147.6mls; P=0.03) and lower transfusion requirements (pooled odds ratio (OR), 0.12, p=0.03). The need for stump revision (OR, 0.7; p=0.48), proceeding to transfemoral amputation within 30 days (OR, 0.67; p=0.25) and 30-day mortality (OR, 0.65; p=0.41) all favoured tourniquet use but the differences were not found to be significant. Conclusion Tourniquets can reduce intra-operative blood loss and transfusion requirements in patients undergoing trans-tibial amputation without increasing ischaemic complications and need for revision surgery. Take-home message Tourniquets are safe to use in trans-tibial amputation for severe peripheral vascular disease and can reduce intra-operative blood loss without increasing ischaemic complications.

Levosimendan administration is not associated with increased risk of bleeding and blood transfusion requirement in patients undergoing off-pump coronary artery bypass grafting: a retrospective study from single center

Perfusion ◽  
2021 ◽  
pp. 026765912110490
Author(s):  
Li-hong Wang ◽  
Xiao-hong Wang ◽  
Jie-chao Tan ◽  
Li-xian He ◽  
Run-qiao Fu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Transfusion Requirement ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Control Group ◽  
Chest Drainage ◽  
Off Pump ◽  
Blood Transfusion Requirement ◽  
Pump Coronary Artery Bypass ◽  
And Control

Background: Levosimendan (LEVO) is a positive inotropic drug which could increase myocardial contractility and reduce the mortality rate in cardiac surgical patients. However, Whether LEVO is associated with postoperative bleeding and blood transfusion in cardiac surgical patients is controversial. Therefore, the current study was designed to investigate the impact of LEVO administration on bleeding and blood transfusion requirement in off-pump coronary artery bypass grafting (OPCAB) patients. Methods: In a retrospective analysis, a total of 292 patients, aged 40–87 years, undergoing elective OPCAB between January 2019 and July 2019, were divided into LEVO group ( n = 151) and Control group ( n = 141). Patients in LEVO group continuously received LEVO at a rate of 0.1–0.2 μg kg−1 min−1 after anesthesia induction until 24 hours after OPCAB or patients in Control group received no LEVO. The primary outcome was postoperative chest drainage volume. The secondary outcomes were reoperation for postoperative bleeding, transfusion requirement of red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrate (PC), etc. Comparisons of two groups were performed with the Student’s t-test or Wilcoxon-Mann-Whitney test. Results: There was no significant difference with respect to chest drainage volume ((956.29 ± 555.45) ml vs (1003.19 ± 572.25) ml, p = 0.478) and the incidence of reoperation for postoperative bleeding (1.32% vs 1.42%, p = 0.945) between LEVO group and Control group. The transfusion incidence and volume of allogeneic RBCs, FFP, and PC were comparable between two groups. Conclusions: LEVO administration was neither associated with more postoperative blood loss nor increased allogeneic blood transfusion requirement in OPCAB patients.

The effect of levosimendan on postoperative bleeding and blood transfusion in cardiac surgical patients: a PRISMA-compliant systematic review and meta-analysis

Perfusion ◽  
2020 ◽  
pp. 026765912096390
Author(s):  
Yun-tai Yao ◽  
Li-xian He ◽  
Yuan-yuan Zhao
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Treatment Effects ◽  
Transfusion Requirement ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Surgical Patients ◽  
Systemic Review ◽  
Increased Risk

Background: Levosimendan (LEVO), is an inotropic agent which has been shown to be associated with better myocardial performance, and higher survival rate in cardiac surgical patients. However, preliminary clinical evidence suggested that LEVO increased the risk of post-operative bleeding in patients undergoing valve surgery. Currently, there has been no randomized controlled trials (RCTs) designed specifically on this issue. Therefore, we performed present systemic review and meta-analysis. Methods: Electronic databases were searched to identify all RCTs comparing LEVO with Control (placebo, blank, dobutamine, milrinone, etc). Primary outcomes include post-operative blood loss and re-operation for bleeding. Secondary outcomes included post-operative transfusion of red blood cells (RBC), fresh frozen plasma (FFP) and platelet concentrates (PC). For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio (OR) and 95% CI. Results: Search yielded 15 studies including 1,528 patients. Meta-analysis suggested that, LEVO administration was not associated with increased risk of reoperation for bleeding post-operatively (OR = 1.01; 95%CI: 0.57 to 1.79; p = 0.97) and more blood loss volume (WMD = 28.25; 95%CI: –19.21 to 75.72; p = 0.24). Meta-analysis also demonstrated that, LEVO administration did not increase post-operative transfusion requirement for RBC (rate: OR = 0.97; 95%CI: 0.72 to 1.30; p = 0.83 and volume: WMD = 0.34; 95%CI: –0.55 to 1.22; p = 0.46), FFP (volume: WMD = 0.00; 95%CI: –0.10 to 0.10; p = 1.00) and PC (rate: OR = 1.01; 95%CI: 0.41 to 2.50; p = 0.98 and volume: WMD = 0.00; 95%CI: –0.05 to 0.04; p = 0.95). Conclusion: This meta-analysis suggested that, peri-operative administration of LEVO was not associated with increased risks of post-operative bleeding and blood transfusion requirement in cardiac surgical patients.

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