Infusion-transfusion therapy in the treatment of acute massive surgical blood loss in cancer surgery

Введение. Расширенные комбинированные вмешательства являются основным методом лечения пациентов с местнораспространенными солидными злокачественными опухолями. Основным следствием масштабной онкохирургии является риск развития острой массивной кровопотери (ОМОК). Цель исследования: оценка переносимости ОМОК у онкологических больных. Материалы и методы. В одноцентровое ретроспективное исследование с января 1999 г. по декабрь 2018 г. были включены 4236 больных, оперированных в радикальном объёме по поводу злокачественных опухолей различных локализаций, течение операции у которых осложнилось ОМОК. Критерием ОМОК являлась потеря ≥ 50% от расчётного объёма циркулирующей крови (ОЦКр) в течение 3 ч операции. Пациенты, вошедшие в исследование, были разделены на 4 группы в зависимости от объёма кровопотери: от 51 до 100%, от 101 до 200%, от 201 до 300% и свыше 300% ОЦКр. Результаты. Пациенты исследованных групп не различались ни по общим показателям, ни по исходному соматическому статусу. Про анализированы качественный и количественный состав инфузионно-трансфузионной терапии (ИТТ), показатели баланса жидкости интраоперационно, продолжительность пребывания пациентов в отделении реанимации и интенсивной терапии, летальность. Заключение. Соблюдение определенного протокола ИТТ при онкологических операциях, осложнённых ОМОК, является залогом успешного лечения и позволяет снизить интраоперационную летальность до 0,8% и госпитальную летальность до 6,45%. Метод аппаратной реинфузии аутоэритроцитов продемонстрировал высокую эффективность. Background. Cancer surgery remains the backbone of treatment approaches in patients with locally advanced solid malignancies. Risk of acute massive blood loss (AMBL) remains the main complication of such large-scale cancer surgery. Objectives: assessment of AMBL tolerance in cancer patients. Patients/Methods. A single- center retrospective study from January 1999 to December 2018 included 4,236 patients who underwent radical surgery for malignant tumors of various localizations, whose course of surgery was complicated with AMBL. The AMBL criterion was the loss of ≥ 50% of the calculated circulating blood volume (СBVс) within 3 hours of the operation. The patients included in the study were divided into 4 groups depending on the volume of blood loss: from 51 to 100%, from 101 to 200%, from 201 to 300% and over 300% of СBVс. Results. Patients of the studied groups did not differ either in general parameters or in baseline somatic status. The qualitative and quantitative composition of infusion-transfusion therapy (ITT), intraoperative fluid balance, patients stay in the intensive care unit, and mortality were analyzed. Conclusions. Compliance with a specific ITT protocol during cancer surgery complicated by AMBL is the key to successful treatment and allows to reduce intraoperative mortality to 0.8% and hospital mortality to 6.45%. The method of intraoperative red cell salvage and autologus transfusion has demonstrated high efficiency.

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Extreme blood loss in cancer surgery: is it a verdict to the patient or a challenge to the staff?

Clinical Practice ◽

10.17816/clinpract10342-48 ◽

2019 ◽

Vol 10 (3) ◽

pp. 42-48 ◽

Cited By ~ 2

Author(s):

Pavel I. Feoktistov ◽

I. E. Кarmanov

Keyword(s):

Blood Loss ◽

Malignant Tumors ◽

Locally Advanced ◽

Venous Access ◽

Multiple Organ ◽

Early Postoperative Period ◽

Cancer Surgery ◽

Septic Complications ◽

Massive Blood Loss ◽

Combined Operations

Background. The development of anesthesiology allows performing combined operations in patients with locally advanced malignant tumors. A logical companion of aggressive cancer surgery is a massive blood loss, which can be so pronounced that it poses a threat to the life of the patient. Objective. The presented experience is an example of transformation of a nearly fatal situation into a curable one and can be useful in choosing an active treatment strategy in most desperate situations. Methods. This research includes 25 patients with the blood loss of 20 liters or more during surgery. Results. The median ratio of infusion to blood loss was 133%, and the ratio of the infusion to all fluid losses amounted to 118%. In 100% of cases, catecholamines were used to support the blood circulation: one drug used in 12% of observations and two to five drugs used in 88% of observations. 2 patients died during the operation. 5 patients died in the early postoperative period from multiple organ failure. The cause of death of another 5 patients was septic complications before the 28th post-op day. Discussion. Performing operations accompanied by acute massive blood loss requires an effective anesthetic support. Conclusions. Enforcement of certain diagnostic and therapeutic conditions (stage construction of anesthesia, hemodynamic and laboratory monitoring, adequate venous access, rational infusion, timely use of catecholamines, using cell-saver device) in the majority of cases allows completing the operation with the surgical control of hemostasis and successfully enduring traumatic and complicated surgery in half of cases.

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Innovative Approach to Surgical Treatment for Locally Advanced Cancer of Paranasal Sinus and Nasal Cavity

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1393 ◽

2021 ◽

Vol 76 (3) ◽

pp. 317-323

Author(s):

Oleg I. Kit ◽

Igor V. Reshetov ◽

Marina A. Engibaryan

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Nasal Cavity ◽

Paranasal Sinus ◽

Malignant Tumors ◽

Locally Advanced ◽

Arterial Embolization ◽

External Carotid Artery ◽

External Carotid ◽

Control Group

Background. Despite the rapid oncology development, the problem of surgical treatment for locally advanced tumors of the paranasal sinus and nasal cavity is still relevant. The search and development of ways to improve the surgical approach, including modern endovascular methods, appears necessary. Aims development and evaluation of the effectiveness of an innovative approach to the surgical treatment of malignant tumors of the nasal cavity and paranasal sinus with superselective intra-arterial embolization as a preparatory stage. Materials and methods. The study is based on the treatment outcomes of 52 patients with cancer of the nasal cavity and paranasal sinus. The main group included 21 patients receiving treatment with our developed approach including preoperative superselective intra-arterial embolization as a preparatory stage for surgical treatment. The control group included 31 patients receiving standard surgical treatment with traditional ligation of the external carotid artery at the first stage. Estimation of the amount of intraoperative blood loss with gravimetric analysis was considered the primary endpoint of the study. Post-embolization syndrome manifestations were analyzed by evaluating the pain intensity with a visual analogue scale and thermometry. Results. Intraoperative blood loss in patients of the main group varied from 100 to 400 ml, being on average 231.9100.58 ml. In the control group, the blood loss varied from 300 ml to 1000 ml, on average 630.97190.23. The data analysis proved demonstratively the effectiveness of the developed approach to surgical treatment of locally advanced tumors of the nasal cavity and paranasal sinus, since it statistically significantly reduced the amount of intoperative blood loss (p 0.005). Conclusions. Our developed approach to the treatment for malignant tumors of the paranasal sinus and nasal cavity optimized the results of surgical treatment and statistically significantly reduced the amount of intoperative blood loss, compared to the traditional ligation of the external carotid artery, from 630.97190.23 to 231.9100.58 ml (p 0.005), with minimal manifestations of post-embolization syndrome.

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STRATEGY OF INFUSION-TRANSFUSION THERAPY IN OPERATIONS WITH MASSIVE BLOODWORK IN CHILDREN WITH TUMOR ABOMALOMAL LOCALIZATION TUMORS

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.30946/2219-4061-2018-8-2-56-64 ◽

2018 ◽

Vol 8 (2) ◽

pp. 56-64 ◽

Cited By ~ 1

Author(s):

E. I. Belousova ◽

N. V. Matinyan ◽

L. А. Martynov

Keyword(s):

Blood Loss ◽

Malignant Tumors ◽

Electrolyte Imbalance ◽

Coagulation System ◽

Infusion Therapy ◽

Transfusion Therapy ◽

Group I ◽

Crystalloid Solutions ◽

Combined Anesthesia ◽

Balanced Crystalloid

Surgeries for thoracoabdominal tumors in children predispose to water and electrolyte imbalance, imbalance in the coagulation system, etc. In spite of abundance of recommendations for children, the volume of basic infusion therapy is uncertain.Study purpose. To estimate the clinical effectiveness of the conducted infusion therapy with isotonic balanced electrolyte solution in children who underwent thoracoabdominal surgeries accompanied with massive blood loss and a complex estimation of the conducted infusion and transfusion therapy.Materials and methods. The intraoperative and early postoperative (days 1–5) periods were analyzed in 22 patients (ASA II–III) who underwent an operation for thoracoabdominal malignant tumors with massive perioperative blood loss in 2016–2017. Group I included 11 patients who had infusion with balanced crystalloid solutions of 5 to 10 ml/kg/hour under combined anesthesia. Group II includes 11 patients who had infusion with balanced crystalloid solutions of 11 to 20 ml/kg/hour under combined anesthesia.Results. According to the conducted study, a higher hemodynamic stability was observed in patients from the group of basic infusion therapy with balanced crystalloid solutions of 11–20 ml/kg/hour. It was expressed as the decrease of the mean dose of the used vasopressors and volume of the infusion of colloidal solutions. The patients also had a less intense response to stress.

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Massive blood loss in pediatric practice

Hematology and Transfusiology ◽

10.35754/0234-5730-2020-65-1-70-86 ◽

2020 ◽

Vol 65 (1) ◽

pp. 70-86 ◽

Cited By ~ 1

Author(s):

K. V. Pshenisnov ◽

Yu. S. Aleksandrovich

Keyword(s):

Blood Loss ◽

High Efficiency ◽

Underlying Disease ◽

Severe Trauma ◽

Multicenter Studies ◽

Circulating Blood Volume ◽

Surgical Interventions ◽

Massive Blood Loss ◽

Pubmed Database ◽

Causes Of Deaths

Background. Massive blood loss is one of the main causes of deaths and complications both in patients requiring extensive surgical interventions and those with severe trauma.Aim. To analyse available publications devoted to the deﬁnition, pathogenesis, diagnosis and intensive care of acute massive blood loss in children.Materials and methods. The conducted analysis involved 102 publications by Russian and foreign authors from the PubMed database devoted to the problem of massive blood loss in children.General ﬁndings. The paper presents modern deﬁnitions of massive blood loss in children. Special attention is paid to the pathogenesis, diagnosis and treatment of massive blood loss in severe trauma cases. The principles of correcting the deﬁciency of circulating blood volume, the use of inotropic and vasopressor drugs, as well as the elimination of severe anemia and hemostasis disorders, are considered. Publications devoted to the search for an optimal ratio of globular and plasma volumes during the transfusion of blood components are reviewed. It is shown that the reviewed publications report conﬂicting opinions regarding the use of antiﬁbrinolytic medications. At the same time, the high efﬁciency of tranexamic acid and its positive effect on the functional outcome in patients with severe trauma is demonstrated. In order to optimize approaches to the management of massive blood loss in children, additional multicenter studies are required. These studies should consider the effect of the underlying disease that caused massive blood loss, as well as the treatment and diagnostic capacity of hospitals.

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Prevention of massive intraoperative bleedings associated with heparin with the systemic use of fibrin monomer in the experiment

ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia» ◽

10.25557/0031-2991.2019.04.48-55 ◽

2019 ◽

pp. 48-55

Author(s):

А.П. Момот ◽

В.М. Вдовин ◽

Д.А. Орехов ◽

Н.А. Лычёва ◽

И.Г. Толстокоров ◽

...

Keyword(s):

Liver Injury ◽

Blood Loss ◽

Unfractionated Heparin ◽

Loss Rate ◽

Antithrombin Iii ◽

Fibrinogen Level ◽

Circulating Blood Volume ◽

Intraoperative Bleeding ◽

Fibrin Monomer ◽

Antithrombin Iii Activity

Цель исследования - изучение способности фибрин-мономера предупреждать тяжелую интраоперационную кровопотерю, ассоциированную с введением нефракционированного гепарина, при дозированной травме печени. Методика. На кроликах «Шиншилла» индуцировали гипокоагуляцию нефракционированным гепарином (150 ед/кг). Профилактику интраоперационных кровотечений осуществляли внутривенным введением фибрин-мономера (0,25 мг/кг) за 1 ч до травмы или протамина сульфата (1,5 мг/кг) за 10 мин до травмы. После нанесения стандартной травмы печени оценивали объем (в % ОЦК) и темп (мг/с) кровопотери. Анализировали число тромбоцитов, активированное парциальное тромбопластиновое время, протромбиновое и тромбиновое время свертывания, уровень фибриногена и активность антитромбина III, параметры ротационной тромбоэластометрии крови. Результаты. Объем кровопотери в группах животных после в/в введения фибрин-мономера и протамина сульфата на фоне гепаринизации был, соответственно, в 5,1 и 4,0 раза меньше по сравнению с группой плацебо, получавшей тот же антикоагулянт. Вместе с тем, фибрин-мономер не влиял на параметры коагулограммы (отсутствие видимого гемостазиологического эффекта) и тромбоэластограммы, тогда как применение протамина сульфата в качестве антидота гепарина сопровождалось нормализацией данных тромбоэластометрии и коррекцией гипокоагуляционного сдвига по активированному парциальному тромбопластиновому времени, протромбиновому и тромбиновому времени. Заключение. Установлено, что фибрин-мономер (0,25 мг/кг) снижает посттравматическое кровотечение в условиях блокады свертывания крови гепарином без видимых признаков восстановления гемостатического равновесия. The research objective was to study the ability of fibrin monomer to prevent severe intraoperative blood loss associated with administration of unfractionated heparin in controlled liver injury. Methods. Hypocoagulation was induced in chinchilla rabbits with unfractionated heparin (150 U/kg). Intraoperative bleeding was prevented by administration of fibrin monomer (FM, 0.25 mg/kg, i.v.) one hour prior to the injury and of protamine sulfate (PS, 1.5 mg/kg, i.v.) 10 min prior to the injury. Following the liver injury, blood loss was assessed as percentage of circulating blood volume and the blood loss rate (mg/s). Platelet counts, aPTT, PT, TT, fibrinogen level, antithrombin III activity, and parameters of blood rotation thromboelastometry were analyzed. Results. The volume of blood loss was 5.1 times and 4.0 times less, respectively, after the FM and PS administration during heparinization compared to the placebo group treated with the same anticoagulant. However, FM affected neither coagulogram indexes (no visible hemostasiological effect) nor thromboelastogram while the use of PS as an antidote for heparin was associated with normalization of thromboelastometric data and correction of hypercoagulative changes in aPTT, PT, TT. Conclusion. FM at a dose of 0.25 mg/kg reduced severity of posttraumatic bleeding induced by heparin inhibition of coagulation with no visible signs of hemostatic balance recovery.

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The Potential of Photoelectrochemical Carbon Sinks

10.26434/chemrxiv.6231140.v2 ◽

2018 ◽

Author(s):

Matthias May ◽

Kira Rehfeld

Keyword(s):

Global Warming ◽

High Temperature ◽

Greenhouse Gas ◽

Large Scale ◽

High Efficiency ◽

Carbon Sink ◽

Solar Fuels ◽

Negative Emissions ◽

Viable Approach ◽

Low Sensitivity

Greenhouse gas emissions must be cut to limit global warming to 1.5-2C above preindustrial levels. Yet the rate of decarbonisation is currently too low to achieve this. Policy-relevant scenarios therefore rely on the permanent removal of CO2 from the atmosphere. However, none of the envisaged technologies has demonstrated scalability to the decarbonization targets for the year 2050. In this analysis, we show that artificial photosynthesis for CO2 reduction may deliver an efficient large-scale carbon sink. This technology is mainly developed towards solar fuels and its potential for negative emissions has been largely overlooked. With high efficiency and low sensitivity to high temperature and illumination conditions, it could, if developed towards a mature technology, present a viable approach to fill the gap in the negative emissions budget.

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The Potential of Photoelectrochemical Carbon Sinks

10.26434/chemrxiv.6231140 ◽

2018 ◽

Author(s):

Matthias May ◽

Kira Rehfeld

Keyword(s):

Global Warming ◽

High Temperature ◽

Greenhouse Gas ◽

Large Scale ◽

High Efficiency ◽

Carbon Sink ◽

Solar Fuels ◽

Negative Emissions ◽

Viable Approach ◽

Low Sensitivity

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Peculiarities of the phytosanitary state of pome fruits in industrial horticulture

POMICULTURE & SMALL FRUITS CULTURE IN RUSSIA ◽

10.31676/2073-4948-2020-60-159-168 ◽

2020 ◽

Vol 60 (1) ◽

pp. 159-168

Author(s):

V. V. Antonenko ◽

A. V. Zubkov ◽

S. N. Kruchina

Keyword(s):

Mechanism Of Action ◽

Large Scale ◽

High Efficiency ◽

Fruit Trees ◽

Fruit Crops ◽

Planting Material ◽

Relative Safety ◽

Pome Fruits ◽

Weed Plants ◽

Spread Of Infection

Data were obtained on the basis of the results of research carried out on the territory of the educational and experimental farm of the Timiryazev State Agrarian University, in Moscow during 2018-2019. As a result of the surveys, the most dangerous diseases and pests of pome crops on the territory of this farm were established. The most resistant apple and pear varieties to major diseases have been identified. Peculiarities of development of alternariosis on pear are described, the harmfulness of the disease on pear and apple seedlings is noted. A possible role in the transfer of alternariosis infection from garden-protective plantations and weed vegetation to fruit trees was noted. A possible role has been established in the transport of septoriosis, powdery dew infection from dicotyledonous weeds plants. The peculiarities of the spread of infection under the influence of wind direction are noted. The results and peculiarities of the application of various methods of scaring birds in the orchard are presented. As a result of route surveys the most harmful weed plants have been identified. The possibility of using herbicides of different mechanism of action in fruit gardens for weed control has been studied. High efficiency and relative safety of application of herbicides of contact action in nursery fields, operational orchards and for control of piglets on fruit trees are shown. Recommendations are given for the use of soil and systemic herbicides of soil in seedlings beds, the first and second fields of the nursery, as well as in the process of production of large-scale planting material and operational orchards of fruit crops. The safety of the herbicides in question is established when used in accordance with the recommended methods of use.

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A high efficiency scheme for large-scale satellite mobile messaging systems

10.1049/cp.2009.1234 ◽

2009 ◽

Cited By ~ 5

Author(s):

O. del Rio Herrero ◽

R. De Gaudenzi

Keyword(s):

Large Scale ◽

High Efficiency

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Functionalization of Congo red dye as a light harvester on solar cell

Open Chemistry ◽

10.1515/chem-2020-0034 ◽

2020 ◽

Vol 18 (1) ◽

pp. 287-294

Author(s):

Harsasi Setyawati ◽

Handoko Darmokoesoemo ◽

Irmina Kris Murwani ◽

Ahmadi Jaya Permana ◽

Faidur Rochman

Keyword(s):

Solar Cell ◽

Congo Red ◽

Large Scale ◽

High Efficiency ◽

Solar Cell Device ◽

Dye Sensitized ◽

Congo Red Dye ◽

Elemental Analyses ◽

Red Dye ◽

Solar Cell Technology

AbstractThe demands of ecofriendly technologies to produce a reliable supply of renewable energy on a large scale remains a challenge. A solar cell based on DSSC (Dye-Sensitized Solar Cell) technology is environmentally friendly and holds the promise of a high efficiency in converting sunlight into electricity. This manuscript describes the development of a light harvester system as a main part of a DSSC. Congo red dye has been functionalized with metals (Fe, Co, Ni), forming a series of complexes that serve as a novel light harvester on the solar cell. Metal-congo red complexes have been characterized by UV-VIS and FTIR spectroscopy, and elemental analyses. The performance of metal complexes in capturing photons from sunlight has been investigated in a solar cell device. The incorporation of metals to congo red successfully improved of the congo red efficiency as follows: Fe(II)-congo red, Co(II)-congo red and Ni(II)-congo red had efficiencies of 8.17%, 6.13% and 2.65%, respectively. This research also discusses the effect of metal ions on the ability of congo red to capture energy from sunlight.

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