scholarly journals Preoperative embolization in surgical treatment of long bone metastasis: a systematic literature review

2020 ◽  
Vol 5 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Stijn E. W. Geraets ◽  
P. Koen Bos ◽  
Johan van der Stok
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Bone Metastases ◽  
Transfusion Requirement ◽  
Primary Tumour ◽  
Significant Risk ◽  
Long Bone ◽  
Preoperative Embolization ◽  
Long Bones ◽  
Perioperative Blood Loss

Surgery of long bone metastases is associated with a significant risk of perioperative blood loss, which may necessitate blood transfusion. Successful embolization (> 70% obliteration of vascularity) can be achieved in 36–75% of cases. The reported rate of embolization-related complications is 0–9%. Three out of six level III evidence studies showed a reduction in perioperative blood loss and/or blood transfusion requirement after preoperative embolization of renal cell carcinoma metastasis in long bones; three out of six studies did not. One level III evidence study did not show a reduction in perioperative blood loss and/or transfusion requirement after preoperative embolization of hepatocellular carcinoma metastases in long bones. There were no studies found that support preoperative embolization of thyroid metastases or other frequent long bone metastases (e.g. mamma carcinoma, lung carcinoma, or prostate carcinoma). The clinical level of evidence of the studies found is low and randomized studies taking into account primary tumour, location of metastases and type of surgery are therefore desired. Cite this article: EFORT Open Rev 2020;5:17-25. DOI: 10.1302/2058-5241.5.190013

scholarly journals The first report of direct skeletal attachment method applying for tibia prosthetic leg in a chicken by cortical screw

2019 ◽  
Vol 2 (3) ◽  
pp. 3-5
Author(s):  
Piyabongkarn Damrongdej
Keyword(s):  
Stainless Steel ◽  
Blood Loss ◽  
Endotracheal Tube ◽  
Surgical Procedure ◽  
Small Animal ◽  
Long Bone ◽  
Long Bones ◽  
First Report ◽  
Cortical Screw ◽  
Intramedullary Screw

This is the first report of successful method for direct skeletal attachment for invent tibia prosthetic leg in a chicken amputee by using 3.0 mm stainless steel cortical screw as an intramedullary bone stem for right tibia endoprosthesis leg part and using acrylic with some part of endotracheal tube as an exoprosthesis leg part. This surgery was performed in a chicken amputee without bone cement using. A chicken could stand and sometime walk after 15 days of surgery. No complication problem with a screw’s stump. This intramedullary bone stem technique by a screw can adapt using in other parts of long bone animal amputee. This technique can apply for invent endoprosthesis limb in other small animal amputees and can use intramedullary screw technique with other long bones such as femur, humerus, radius, and ulna because this technique uses only one stainless 316L screw so the surgery cost is not too much. The surgical procedure is not complicated and blood loss during surgery is not much so the risk for this technique is low.

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.

scholarly journals Szükség van szívódrénre elektív csípőprotézis-műtétek során?

2016 ◽  
Vol 157 (29) ◽  
pp. 1171-1176
Author(s):  
Tibor Major ◽  
András Bikov ◽  
Gergely Holnapy ◽  
Zoltán Bejek ◽  
Bernadett Bakos ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Transfusion Requirement ◽  
Postoperative Hemorrhage ◽  
Thrombosis Prophylaxis ◽  
Suction Drainage ◽  
Septic Complications ◽  
Suction Drain ◽  
Perioperative Blood Loss

Introduction: Several studies have been published which questioned the use of suction drain during elective hip arthroplasty. Aim: In this prospective study the authors examined how the use of suction drainage affected complications related to perioperative blood loss and hemorrhage in patients undergoing elective hip arthroplasty. Method: Eighty-six patients undergoing elective hip arthroplasty were divided into two groups. In 54 patients (“drain” group) suction drains were used during operation, whereas in 32 patients no suction drain was applied. Perioperative blood loss, use of tranexamic acid, method of thrombosis prophylaxis, transfusion requirement, incidental postoperative hemorrhage, septic complications, and all other postoperative complications were recorded. Results: Perioperative blood loss was affected with the use of tranexamic acid but not with the use of drainage (p = 0.94). Patients without the use of drain showed a tendency of lower transfusion requirement (p = 0.08). There was no correlation between any complications and the use of drainage. Conclusion: In accordance with published results the authors conclude that the routine use of suction drainage during elective hip arthroplasty is not definitely necessary. Orv. Hetil., 2016, 157(29), 1171–1176.

scholarly journals 1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Varma ◽  
R Donovan ◽  
M Whitehouse ◽  
S Kunutsor ◽  
A Blom
Keyword(s):  
Systematic Review ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Meta Analysis ◽  
Postoperative Blood Loss ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements ◽  
Elbow Replacement

Abstract Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER). We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications. Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay. This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.

scholarly journals Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA 

2020 ◽  
Author(s):  
Huiping Wei ◽  
Qiuping Xiao ◽  
Jianfeng He ◽  
Tianji Huang ◽  
Wantang Xu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Elderly Patients ◽  
Tranexamic Acid ◽  
Topical Application ◽  
Control Group ◽  
Specific Method ◽  
Intertrochanteric Fractures ◽  
Perioperative Blood Loss ◽  
Perioperative Bleeding

Abstract Background: The specific method and dose of tranexamic acid (TXA) topically applied for intertrochanteric fractures have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically administered via our protocol for perioperative bleeding management in elderly patients with intertrochanteric fractures who underwent proximal femoral nail anti-rotation (PFNA).Methods: A retrospective comparative analysis was performed. The TXA group was composed of 82 patients with topical use of TXA, and the control group was composed of 82 patients without TXA use during the PFNA procedure. Intraoperative, total and hidden amounts of blood loss, drainage volumes, postoperative blood transfusion volumes and complications were compared between the two groups.Results: The intraoperative, total and hidden amounts of blood loss and the drainage volumes were significantly lower in the TXA group than in the control group (P=0.012, P<0.01, P<0.01, P=0.014, respectively). The volume and rate of blood transfusion in the TXA group were significantly lower than those in the control group (P<0.01). There were no significant differences in complications between the two groups (P>0.05).Conclusion: Topical application of TXA offers an effective and safe option for reducing perioperative blood loss and transfusion in elderly patients with intertrochanteric fractures undergoing PFNA.

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.

scholarly journals Efficacy of Tranexamic Acid in Pediatric Craniosynostosis Surgery

2011 ◽  
Vol 114 (4) ◽  
pp. 862-871 ◽  
Author(s):  
Susan M. Goobie ◽  
Petra M. Meier ◽  
Luis M. Pereira ◽  
Francis X. McGowan ◽  
Randy P. Prescilla ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Plasma Concentrations ◽  
Secondary Outcome ◽  
Double Blind ◽  
Total Blood ◽  
Reconstruction Surgery ◽  
Perioperative Blood Loss ◽  
The Difference

Background Extensive blood loss is common in pediatric craniosynostosis reconstruction surgery. Tranexamic acid (TXA) is increasingly used to reduce perioperative blood loss in various settings, but data on its efficacy are limited in children. The purpose of this randomized, double-blind, placebo-controlled, parallel trial was to evaluate the efficacy of TXA in pediatric craniosynostosis correction surgery. The primary and secondary outcome variables were reduction in perioperative blood loss and reduction in blood transfusion, respectively. Methods Forty-three children, ages 2 months to 6 yr, received either placebo or TXA in a loading dose of 50 mg·kg(-1), followed by an infusion of 5 mg·kg·h(-1) during surgery. TXA plasma concentrations were measured. Results The TXA group had significantly lower perioperative mean blood loss (65 vs. 119 ml·kg(-1), P &lt; 0.001) and lower perioperative mean blood transfusion (33 vs. 56 ml· kg(-1), P = 0.006) compared to the placebo group. The mean difference between the TXA and placebo groups for total blood loss was 54 ml·kg(-1) (95% CI for the difference, 23-84 ml·kg(-1)) and for packed erythrocytes transfused was 23 ml·kg(-1) (95% CI for the difference, 7-39 ml·kg(-1)). TXA administration also significantly diminished (by two thirds) the perioperative exposure of patients to transfused blood (median, 1 unit vs. 3 units; P &lt; 0.001). TXA plasma concentrations were maintained above the in vitro thresholds reported for inhibition of fibrinolysis (10 μg·ml(-1)) and plasmin-induced platelet activation (16 μg·ml(-1)) throughout the infusion. Conclusions TXA is effective in reducing perioperative blood loss and transfusion requirement in children undergoing craniosynostosis reconstruction surgery.

scholarly journals Monitoring of mitochondrial oxygenation during perioperative blood loss

2021 ◽  
Vol 14 (1) ◽  
pp. e237789
Author(s):  
Floor A Harms ◽  
Alexandra R M Brandt-Kerkhof ◽  
Egbert G Mik
Keyword(s):  
Case Report ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Oxygen Tension ◽  
Acute Blood Loss ◽  
Monitoring Technique ◽  
Perioperative Blood Loss ◽  
Oxygen Measurements ◽  
Additional Monitoring

One of the challenges in the management of acute blood loss is to differentiate whether blood transfusion is required or not. The sole use of haemoglobin values might lead to unnecessary transfusion in individual cases. The suggestion is that mitochondrial oxygen tension can be used as an additional monitoring technique to determine when blood transfusion is required. In this case report, we report mitochondrial oxygen measurements in a patient with perioperative blood loss requiring blood transfusion.

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