Common haemostatic techniques used in surgical practice

2021 ◽  
Vol 82 (8) ◽  
pp. 1-8
Author(s):  
Georgina H Frew ◽  
Lachlan Dick ◽  
Jamie Young
Keyword(s):  
Blood Loss ◽  
Patient Outcomes ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding ◽  
Surgical Practice ◽  
Key Factor ◽  
Bloodless Field

Intraoperative bleeding can be difficult to manage and is associated with worse patient outcomes. Good intraoperative haemostasis by the surgeon is a key factor in ensuring a bloodless field and reducing intraoperative blood loss. There is a myriad of mechanical, thermal and energy-based techniques available to use, each of which has their own benefits and drawbacks. The decision of which to use will depend on patient and procedural factors as well as the surgeon's preference. This article reviews techniques commonly used in surgical practice to maintain intraoperative haemostasis.

scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

scholarly journals Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshikazu Nagase ◽  
Shinya Matsuzaki ◽  
Masayuki Endo ◽  
Takeya Hara ◽  
Aiko Okada ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Cesarean Delivery ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Multivariate Regression ◽  
Placenta Previa ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

scholarly journals Effect of premedication with oral clonidine on intraoperative blood loss during rhinoplasty surgery - A systematic review

2020 ◽  
Vol 11 (4) ◽  
pp. 5206-5213
Author(s):  
Sudarssan Subramaniam Gouthaman ◽  
Janani Kandamani ◽  
Divya Sanjeevi Ramakrishnan ◽  
P. U. Abdul Wahab
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Surgical Procedure ◽  
Intraoperative Blood Loss ◽  
Pertinent Literature ◽  
Intraoperative Bleeding ◽  
Oral Clonidine ◽  
Hypotensive Anaesthesia ◽  
The Past ◽  
Manual Search

Rhinoplasty is one frequent surgical procedure of many technical variations that only a few surgeons are considered to have mastered its broad scope. Operative site bleeding is considered to be an exasperating issue in the surgical procedure of rhinoplasty. Over the past few decades, the strategy of lowering patient's blood pressure during anaesthesia or "Hypotensive anaesthesia" has been practised to reduce the blood loss during surgeries. Clonidine is an antihypertensive drug and is suggested to have advantageous effects in controlling the intraoperative blood loss. The objective of this systematic review was to explore and study the existing literature and determine the efficacy of oral clonidine as a premedication in reducing the intraoperative blood loss in rhinoplasty surgeries. Data was gathered from electronic databases like PubMed, Medline and Cochrane central library. An additional manual search was performed with various journals to look for available articles to include in the systematic review. Only those studies which met the criteria for inclusion were selected. All studies and reports that evaluated oral clonidine with placebo in reducing bleeding during rhinoplasty surgery were included. Pertinent literature abstracts and full-text articles pertaining to the query were analysed. Two articles in total were taken in for qualitative analysis, both of which were randomised clinical trials. Oral clonidine shows significantly more efficient in reducing intraoperative bleeding than the placebo group. Premedication with oral clonidine is significantly effective in controlling blood loss during the surgical procedure of rhinoplasty.

Thrombin, Fibrin Monomer and Factor XIII in Patients with Unexplained Intraoperative Bleeding.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4025-4025
Author(s):  
Wolfgang C. Korte ◽  
Konrad Gabi ◽  
Anita Gähler ◽  
Thomas Schnider ◽  
Walter Riesen
Keyword(s):  
Blood Loss ◽  
Factor Xiii ◽  
Elective Surgery ◽  
Monomer Concentration ◽  
Coagulation Cascade ◽  
Intraoperative Blood Loss ◽  
Double Blind ◽  
Intraoperative Bleeding ◽  
Fibrin Monomer ◽  
Preoperative Risk Stratification

Abstract To explore relevant changes in unexplained intraoperative bleeding, we evaluated elements of the final steps of the coagulation cascade in 226 consecutive patients undergoing elective surgery. Patients were stratified for the occurrence of unexplained intraoperative bleeding according to predefined criteria. Twenty patients (8.8%) developed unexplained bleeding. Median intraoperative blood loss was 1350 ml (bleeders) and 400 ml (non-bleeders), p<0.001. Fibrinogen and factor XIII were more rapidly consumed in bleeders (p<0.001). Soluble fibrin formation (fibrin monomer) was elevated in bleeders throughout surgery (p < 0.014, table 1). However, F. XIII availability per unit thrombin generated was significantly decreased in bleeders pre-, intra- and postoperatively (p < 0.051). Computerized thrombelastography showed a parallel, significant reduction in clot firmness. We suggest that a mild, pre-existing coagulopathy is not rare in surgical patients and probably can result in clinically relevant intraoperative bleeding. This haemostatic disorder shows impaired clot firmness, probably secondary to decreased cross-linking (due to a loss of F. XIII, both in absolute measures and per unit thrombin generated). We are currently conducting a double blind, randomized trial on the use of F. XIII early during surgery. We suggest that the preoperative measurement of fibrin monomer concentration might allow preoperative risk stratification for intraoperative blood loss. Fibrin Monomer is increased in “bleeders” Non-Bleeder (FM median μg/l) Bleeder (FM median μg/l) p (Rank Sum test) T1 (preop) 7 18 <0.01 T2 (intraop) 6 14 <0.01 T3 (intraop) 9 20 0.014 T4 (postop) 26 52 <0.01 T5 (postop) 29 86 <0.01

scholarly journals Geometric Alopecia after Preoperative Angioembolization of Juvenile Nasopharyngeal Angiofibroma

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0048 ◽  
Author(s):  
Alejandro Vazquez ◽  
Pratik A. Shukla ◽  
Osamah J. Choudhry ◽  
Chirag D. Gandhi ◽  
James K. Liu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Radiation Exposure ◽  
Skull Base ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma ◽  
Intraoperative Bleeding

Resection of a juvenile nasopharyngeal angiofibroma (JNA) is challenging because of high intraoperative blood loss secondary to the tumor's well-developed vascularity. Endoscopic sinus and skull base surgeons commonly collaborate with neurointerventionalists to embolize these tumors before resection in an attempt to reduce the vascular supply and intraoperative bleeding. However, angioembolization can be associated with significant complications. Geometric alopecia from angioembolization of JNA has not been previously reported in the otolaryngologic literature. In this study, we discuss geometric alopecia from radiation exposure during preoperative angioembolization of a JNA.

scholarly journals Comparison of Ultrasonic Device Versus Bipolar Diathermy Tonsillectomy in Children

2019 ◽  
Vol 17 (01) ◽  
pp. 71-75
Author(s):  
Mukesh Kumar Sah ◽  
Yogesh Neupane ◽  
Rajendra Prasad Guragain
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Intraoperative Blood Loss ◽  
Bipolar Diathermy ◽  
Analog Scale ◽  
Intraoperative Bleeding ◽  
Ultrasonic Device ◽  
Post Operative Pain ◽  
The Mean ◽  
Group Post

Background: Intraoperative bleeding and postoperative pain are two commonest concerns for both patient and surgeon in tonsillectomy. This study was aimed to compare intraoperative blood loss and early postoperative pain between ultrasonic device and bipolar diathermy tonsillectomy in children.Methods: Prospective, interventional, single blinded, comparative study was carried out from September 2016 to September 2017 including children up to age 15 years who underwent tonsillectomy either by bipolar diathermy or ultrasonic device. Intraoperative blood loss was recorded using standard sized gauge technique. Post-tonsillectomy pain on first five postoperative days (early postoperative pain) was assessed using Visual analog scale for children older than 5 years and FLACC score for children up to 5 years respectively.Means were compared.Results: 38 children (76 tonsils) were included in the study out of which 31 were boys (62 tonsils) and 7 were girls (14 tonsils). The mean intraoperative blood loss in ultrasonic dissection group was 13.94 ml and 13.91 ml in bipolar diathermy group. This difference was not statistically significant (p=0.974). Post-operative pain on 1st, 2nd, 3rd and 4th days were significantly less (p<0.05) in ultrasonic device group compared to bipolar diathermy group. Post-operative pain was less also on 5th post-operative day in ultrasonic device but was not statistically significant (p=0.172).Conclusions: Tonsillectomy in children using ultrasonic device did not differ from bipolar diathermy tonsillectomy in respect to intraoperative blood loss. However, early postoperative pain was significantly lower in ultrasonic device group.Keywords: Bipolar diathermy; tonsillectomy; ultrasonic device.

Effect of Fibrinogen Concentrate on Intraoperative Blood Loss Among Patients With Intraoperative Bleeding During High-Risk Cardiac Surgery

JAMA ◽  
2017 ◽  
Vol 317 (7) ◽  
pp. 738 ◽  
Author(s):  
Süleyman Bilecen ◽  
Joris A. H. de Groot ◽  
Cor J. Kalkman ◽  
Alexander J. Spanjersberg ◽  
George J. Brandon Bravo Bruinsma ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Blood Loss ◽  
Intraoperative Blood Loss ◽  
Fibrinogen Concentrate ◽  
Intraoperative Bleeding

scholarly journals Coblation vs. dissection tonsillectomy: a prospective randomized study comparing surgical and clinical outcomes

2019 ◽  
Vol 5 (2) ◽  
pp. 306
Author(s):  
Shifa Vyas ◽  
Pritosh Sharma ◽  
Nitin Sharma ◽  
Abhijit Makwana ◽  
V. P. Goyal
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Randomized Study ◽  
Postoperative Bleeding ◽  
Intraoperative Blood Loss ◽  
Surgical Time ◽  
Intraoperative Bleeding ◽  
Time Required ◽  
Pain Patients ◽  
Better Than

<p class="abstract"><strong>Background:</strong> The objective of this study is to compare operative time, intraoperative bleeding, postoperative pain between coblation and dissection tonsillectomy.</p><p class="abstract"><strong>Methods:</strong> A total of 62 patients who met the inclusion criteria were divided into two groups according to the surgical procedure they went through. Surgical time intraoperative blood loss, postoperative pain, postoperative regaining of activity and any episode of postoperative bleeding were noted in both the groups and compared.  </p><p class="abstract"><strong>Results:</strong> Coblation tonsillectomy fared better than dissection tonsillectomy in terms of having less intraoperative blood loss, less postoperative pain. Patients who underwent coblation assisted tonsillectomy also had earlier return to normal activities. Though the time required for coblation tonsillectomy was more than dissection tonsillectomy there were no episodes of postoperative bleeding in subjects who underwent coblation tonsillectomy.</p><p class="abstract"><strong>Conclusions:</strong> Coblation assisted tonsillectomy is a promising new technique for tonsillectomy as patients had less postoperative morbidity mainly pain. The surgical time required could be reduced further with experience.</p>

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