scholarly journals Finding the Optimal Regimen for Short-Term Daily Recombinant Human Erythropoietin Treatment for Blood-Saving Purpose in Patients undergoing Unilateral Primary Total Hip Arthroplasty: A Double-Blinded Randomized Placebo-Controlled Trial

2021 ◽  
Author(s):  
Mingcheng Yuan ◽  
Qifeng Tao ◽  
Duan Wang ◽  
Haoyang Wang ◽  
Zongke Zhou
Keyword(s):  
Blood Loss ◽  
Normal Saline ◽  
Small Dose ◽  
Total Blood Loss ◽  
Short Term ◽  
Total Blood ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Purpose: To find the best short-term daily rhEPO-based treatment protocols for blood-saving purpose in THA.Method: The patients were randomized to 1 of 3 interventions: Patients in group A received 10,000 IU (150IU/kg) of subcutaneous rhEPO (1 ml) daily from 5 days preoperatively to 3 days postoperatively (9 doses in total); Patients in group B received 1 ml of subcutaneous normal saline daily from 5 days preoperatively to 4 days preoperatively and then 10,000 IU (150IU/kg) of subcutaneous rhEPO daily till 3 days postoperatively (6 doses in total). Patients in group C received 1 ml of subcutaneous normal saline daily from 5 days preoperatively to one day preoperatively and then 10,000 IU (150IU/kg) of subcutaneous rhEPO daily from the day of surgery to 3 days postoperatively (4 doses in total). Results: 180 patients were included. On postoperative day one, patients in the group A showed significantly higher Hb level (108.4±11.4 g/L) than group B and C (107.8±8.4 and 103.9±8.8 g/L, respectively) (p<0.001), the Hb level in group B was also markedly higher than in group C (p=0.045). On postoperative day 3, no significant difference was found between group B and C in Hb level (98.7±10.5 and 94.9±8.7 g/L, respectively) (p=0.094), but the Hb level in group A (103.6±11.0 g/L) was still markedly higher than in group B and C. In terms of blood loss, no markedly difference was found in intraoperative blood loss among group A, B and C (78.3±22.4, 84.6±29.1, and 80.3±23.9 ml, respectively) (p=0.381), but on postoperative day one, the mean blood loss was significantly more in groups B and C (371.2±124.6, and 522.4±189.4 ml, respectively) than in group A (284.8±112.9 ml) (p<0.001), and group B had significantly less blood loss than group C (p<0.001). With respect to the total blood loss, group B and C had markedly more total blood loss (642.6±232.9, and 881.6±314.9 ml, respectively) than group A (514.5±204.6 ml) and group B had significantly less blood loss than group C (p<0.001) (Table 2). Only 2 patients in each group received allogeneic blood transfusion and each patient received 2 units of red blood cells, so, the transfusion requirements among the three groups were comparable.Conclusions: Daily small-dose of subcutaneous rhEPO administered from 5 days before THA could significantly decrease perioperative blood loss and improve postoperative Hb levels, without increasing risks of complications, when compared with the application of rhEPO from 3 days before THA or from the day of surgery. Therefore, we recommend the more practical and highly effective therapeutic regimen of small-dose of subcutaneous rhEPO daily from 5 days preoperatively to 3 days postoperatively for patients scheduled for THA.

scholarly journals Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao-Yang Wang ◽  
Liu Wang ◽  
Ze-Yu Luo ◽  
Duan Wang ◽  
Xin Tang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Blood ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

scholarly journals A COMPARATIVE STUDY OF ASSESSMENT OF ROLE OF TRANEXAMIC ACID IN CONTROLLING BLOOD LOSS IN ORTHOPAEDIC SURGERIES: A RANDOMISED CONTROL TRIAL.

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Deepak Kumar ◽  
Santosh Kumar
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Total Blood Loss ◽  
Randomised Control Trial ◽  
Blood Transfusions ◽  
Total Blood ◽  
Post Operative Period ◽  
Group A ◽  
Group B

Aim: to study the role of Tranexamic Acid in Controlling Blood Loss In orthopaedic surgeries. Material & Methods: 50 patients were included in the study during the study period. Patients were randomly allotted to 2 groups of equal participants. The first group (Group A) received Tranexamic Acid. The second group (Group B) was given Normal saline as placebo. The Total Blood Loss ( intra operative + post operative ) and Fall in Haemoglobin levels were measured post-operatively at 24 and 72 hrs of post-operative period. Result: The group A had showed significantly reduced total blood loss and fall in Haemoglobin, thus, requiring fewer blood transfusions. No complications were observed. Conclusions: the present investigation concluded that Tranexamic acid can be effective in reducing blood loss and subsequent fall in haemoglobin. Keywords: Tranexamic acid, Bleeding, Major Orthopaedic surgeries.

Effect of short-term use of oral contraceptive pills on intraocular pressure

2020 ◽  
Vol 35 (3) ◽  
Author(s):  
Tayyaba Gul Malik ◽  
Hina Nadeem ◽  
Eiman Ayesha ◽  
Rabail Alam
Keyword(s):  
Oral Contraceptive ◽  
Childbearing Age ◽  
Short Term ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Time Period ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Short Time

Objective: To study the effect of short-term use of oral contraceptive pills on intra-ocular pressures of women of childbearing age.   Methods: It was a comparative observational study, conducted at Arif memorial teaching hospital and Allied hospital Faisalabad for a period of six months. Hundred female subjects were divided into two groups of 50 each. Group A, included females, who had been taking oral contraceptive pills (OCP) for more than 6 months and less than 36 months. Group B, included 50 age-matched controls, who had never used OCP. Ophthalmic and systemic history was taken. Careful Slit lamp examination was performed and intraocular pressures (IOP) were measured using Goldman Applanation tonometer. Fundus examination was done to rule out any posterior segment disease. After collection of data, we analyzed and compared the intra ocular pressures between the two groups by using ANOVA in SPSS version 21.   Results: Average duration of using OCP was 14.9 months. There was no significant difference of Cup to Disc ratios between the two groups (p= 0.109). However, significant difference was noted between the IOP of OCP group and controls. (p=0.000). Conclusion: OCP significantly increase IOP even when used for short time period.

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

Evaluating the Role of Anesthesia on Intraoperative Blood Loss and Visibility during Endoscopic Sinus Surgery: A Meta-analysis

2021 ◽  
pp. 194589242198915
Author(s):  
David C. Moffatt ◽  
Robert A. McQuitty ◽  
Alex E. Wright ◽  
Tawanda S. Kamucheka ◽  
Ali L. Haider ◽  
...  
Keyword(s):  
Heart Rate ◽  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Average Rate ◽  
Meta Analysis ◽  
Sinus Surgery ◽  
Total Blood Loss ◽  
Total Blood ◽  
Intraoperative Bleeding ◽  
Significant Difference

Background Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility. Objective To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility. Methods A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP). Results 19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (−0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (−0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (−0.225, p = 0.63) and MAP values (−0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent. Conclusion TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.

scholarly journals Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

2021 ◽  
Vol 8 (5) ◽  
pp. 1507
Author(s):  
Amit Yadav ◽  
Lakshman Agarwal ◽  
Sumit A. Jain ◽  
Sanjay Kumawat ◽  
Sandeep Sharma
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Wound Infection ◽  
Skin Incision ◽  
P Value ◽  
Wound Area ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

scholarly journals Comparative Study of Efficiency between Povidone Iodine and Normal Saline Lavage in the Treatment of Acute Peritonitis

2018 ◽  
Vol 4 (1) ◽  
pp. 15-20
Author(s):  
Haridas Saha ◽  
Mohammad Ibrahim Khalil ◽  
Aminul Islam ◽  
Abdullah Al Mamun ◽  
Md Margub Hossain
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Normal Saline ◽  
Povidone Iodine ◽  
Medical College ◽  
Acute Peritonitis ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Saline Lavage

Background: Control of the primary site of sepsis is the main determinant of good surgical outcome. Objective: The purpose of the present study was to compare the efficiency between povidone iodine and normal saline lavage in the treatment of acute peritonitis. Methodology: This was a randomized clinical trial conducted in the Department of Surgery at Dhaka Medical College & Hospital, Dhaka, Bangladesh. Patients with acute peritonitis due to gastrointestinal causes who were admitted in the different units of Dhaka Medical College Hospital during the study period were selected as study population. Among them patients who were treated with povidone iodine were enrolled in the present study in group A and patients who were treated with conventional normal saline were in group B. Results: A total number of 1050 patients were recruited for this study. Among them 100 patients were enrolled in the present study of which group A (50 patients) for povidone iodine and group B (50 patients) for conventional normal saline. On 7th POD wound infection was found in Group A and Group B were 11(22.4%) and 21(44.7%) respectively. Statistically significant difference in post operative complication of wound infection was observed on 7th POD between the groups (p<0.05). Post operative hospital stay in Group A and Group B were 11.50 ± 4.48 and 13.46 ± 5.13 days respectively. There is statistically significant difference in post operative hospital stay between the groups (p<0.05). Conclusion: Statistically significant difference observed in post operative complication of wound infection and burst abdomen on 7th POD between the groups. The present study there is statistically significant difference in post operative hospital stay between the groups also observed. Bangladesh Journal of Infectious Diseases 2017;4(1):15-20

scholarly journals Per-operative Advantages of Transanal Endorectal Pull Through (TERPT) Over Swenson’s Procedure in the Surgical Treatment of Rectosigmoid Hirschsprung’s Disease (HD)

1970 ◽  
pp. 16-20
Author(s):  
Abu Saleh Md Waliullah ◽  
Shoheli Alam ◽  
MA Aziz ◽  
AR Khan
Keyword(s):  
Blood Loss ◽  
Transfusion Requirement ◽  
Control Group ◽  
Operative Duration ◽  
Transfusion Requirements ◽  
Study Results ◽  
Group A ◽  
Pull Through ◽  
Group B ◽  
A Prospective Study

Introduction: Popular Swenson's pull through (1948) is still the most commonly practiced 'Gold Standard' of operative treatment for rectosigmoid hirschsprung's disease (HD). But minimally invasive transanal endorectal pull through (TERPT) is now being increasingly practiced worldwide for its treatment in many centers. Here we are describing our comparative experience between TERPT and Swenson's pull through, at Dhaka Shishu Hospital to show the per-operative advantages of the former over the latter. Materials and methods: It is a prospective study at Dhaka Shishu Hospital during January 2000 to December 2001 in 32 (age, body weight and resected Rectosigmoid length matched) biopsy confirmed patients of HD divided into two Groups: Gr. A (na = 16) and Gr. B (nb = 16) patients who underwent TERPT and Swenson's pull through respectively. Unpaired 't' and χ2 (with Yate's correction) tests were used for statistical analysis whereas operative duration, volume of blood loss and transfusion requirements were used as parameters of the study. Results: For study Group A (TERPT) - operative time, volume of blood loss and transfusion requirement were significantly lesser (P < 0.01, P < 0.001 and P < 0.001 respectively) than the control Group B (Swenson's procedure). Conclusions: Through this small comparative study, TERPT was found to be more advantageous than the Swenson's pull through procedure in terms of operative duration, blood loss and transfusion requirement. Key words: TERPT; Swenson's; Compare. DOI: 10.3329/bjch.v31i1.6068 Bangladesh Journal of Child Health 2007; Vol.31(1-3): 12-15

scholarly journals Effect of Tranexamic Acid after Cardiac Surgery in Children

1970 ◽  
Vol 1 (2) ◽  
pp. 189-192
Author(s):  
MK Hassan ◽  
KA Hasan ◽  
ABMA Salam ◽  
A Razzak ◽  
S Ferdous ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Pediatric Patients ◽  
Acid Group ◽  
Skin Incision ◽  
Total Blood Loss ◽  
Financial Cost ◽  
Total Blood ◽  
Transfusion Requirements

Background: The antifibrinolytic drug tranexamic acid (TA) decreases blood loss in Pediatric patients under going cardiac Surgery. However its efficacy has not been extensively studied in children. Method: We examined 750 children under going cardiac surgery form 2004 to 2007 in National Institute of Cardiovascular Diseases (NICVD), 379 children in the Tranexamic Acid group (TA) and 371 included in placebo (P) group. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (10mg/kg followed by 1mg/kg/hr) and saline placebo. After admission to intensive care unit total blood loss and transfusion requirements during the first12 hours were recorded. Result: Children who were treated with tranexamic acid had 24% less total blood loss (26±7 vs 34±17 ml/kg) compared with children who received placebo (p<0.05). Additionally, the total transfusion requirements, total donor unit exposure and financial cost of blood components were less in the tranexamic acid group. Conclusion: Tranexamic acid can reduce perioperative blood loss in children undergoing cardiac surgery.Keywords: Tranexemic acid; Cardiac surgery; Post operative; bleeding DOI: http://dx.doi.org/10.3329/cardio.v1i2.8127 Cardiovasc. j. 2009; 1(2) : 189-192

scholarly journals COMPARISON OF HEMODYNAMIC STATUS AND COMPLICATIONS BETWEEN TWO DIFFERENT DOSES OF INTRAMYOMETRIAL VASOPRESSIN DURING LAPAROSCOPIC MYOMECTOMY: A RETROSPECTIVE STUDY, THE LESSER THE BETTER

2021 ◽  
pp. 111-113
Author(s):  
NUPUR MODA ◽  
SUSHREE DAS ◽  
MADHUSMITA PATRO ◽  
PRERNA BISWAL
Keyword(s):  
Retrospective Study ◽  
Side Effects ◽  
Blood Loss ◽  
Normal Saline ◽  
Airway Pressure ◽  
Laparoscopic Myomectomy ◽  
Hemodynamic Status ◽  
Group A ◽  
Group B ◽  
Different Doses

Objective: Our aim is comparison of hemodynamic status and complications between two different doses of intramyometrial vasopressin during laparoscopic myomectomy. Methods: We did a retrospective analysis of hemodynamic status and its anesthetic concerns in patients who received two different doses of intramyometrial vasopressin. Eighty patients undergoing laparoscopic myomectomy under general anesthesia were divided into two groups of 40 patients in each group. In Group A (n=40), 10 units of intramyometrial vasopressin in 200 ml of normal saline were given and, in Group B, 20 units of intramyometrial vasopressin in 200 ml of NS were given intraoperatively by surgeon. Results: 20 units intramyometrial vasopressin used dogmatically by surgeons drops blood loss but it is connected with cardiovascular impediments. Hence, 10 units of intramyometrial vasopressin as compared to 20 units which are used by some surgeons are associated with similar blood loss and lesser side effects such as bradycardia, pulmonary edema, hypotension, blood loss, and increased airway pressure. Conclusion: Hence, anesthesiologists and gynecologists must take the precautions to escape and minimize the frequency of impediments with intramyometrial vasopressin by selecting the appropriate dosage of vasopressin.

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