Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= −0.15; 95%CI: −0.23 to −0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= −0.51; 95%CI: −0.57 to −0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= −1.43; 95%CI: −2.27 to −0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.

Minimally invasive Fothergill -Manchester operation with connective tissue conservation

Our minimally invasive Fothergill-Manchester technique aims to decrease blood loss and surgical trauma and to preserve function by1. Vaginal conservation. 2. Cardinal (CL) and uterosacral (USL) ligaments plicated, not severed. 3. Direct suture of vagina to cervix without Sturmdorf sutures after cervical amputation. 4. Use of No2 polyester sutures to create new collagen to reinforce the plicated ligaments.

Intravenous Tranexamic Acid Decreases Blood Transfusions and Blood Loss for Patients with Surgically Treated Hip Fractures

Introduction Tranexamic acid can decrease blood loss related to surgery and trauma. The primary objective of this study is to examine if the use of a single dose of peri-operative TXA significantly decreases the rate of allogenic blood transfusions in the setting of operative care of hip fractures. Secondary objectives included examining if total blood loss was decreased by TXA in operative hip fractures as well as examining the safety of TXA by measuring the rates venous thromboembolism (VTE). Methods Retrospective chart review of 505 patients who were operatively treated for hip fractures at a single facility was performed. In a non-randomized fashion, 307 patients received TXA and 198 patients did not. Patients received 1 gram of TXA prior to incision. Blood transfusion was the primary end point. Blood loss was calculated using the hemoglobin balance method. Chart was reviewed for VTE events during hospitalization. Results 505 patients were analyzed. The use of single perioperative dose of TXA in the surgical management of hip fracture resulted in absolute risk reduction of transfusion of 7.7% and relative risk reduction of transfusion by 29%. This was statistically significant with P =.04. Patients who received TXA on average lost 235 ml less blood compared to those who did not receive TXA ( P <.0001). No increase in VTE events were found in either group during hospitalization. Conclusion This study supports the use of TXA is decrease blood loss and transfusion rates in patients with hip fractures. TXA can be used routinely to decrease complications in this usually fragile population.

Effect of Continuous Infusion of Dexmedetomidine on Blood Loss in Orthognathic Surgery: A Retrospective Study

Background: Patients with maxillofacial deformities require orthognathic surgeries to correct occlusion. The surgical procedure may lead to massive bleeding, which is associated with hematoma, respiratory obstruction, and asphyxia. Dexmedetomidine has been used in controlled hypotension, and may decrease blood loss in orthognathic surgery. We conducted a retrospective cohort study to evaluate the effect of dexmedetomidine on blood loss in orthognathic surgeries.Methods: The primary outcome examined was blood loss, and secondary outcomes were postoperative haemoglobin level, intraoperative heart rate, and blood pressure (T0: preoperative; T1: at incision; T2: 30 minutes after incision; T3: 60 minutes after incision; T4: 120 minutes after incision); dose of fentanyl, remifentanil, urapidil, and esmolol; operation time; incidence of allogeneic blood transfusion; crystalloid fluids volume; and colloidal fluid volume. Results: A total of 1,247 patients were included in the study, and 557 patient pairs were matched via propensity score matching. There were significant decreases in mean blood loss, heart rate at T1–T4, blood pressure at T1, remifentanil and esmolol dosage, and crystalloid fluid volume in the dexmedetomidine group compared with those in the control group. There was also a significant increase in the postoperative haemoglobin level of the dexmedetomidine group. Conclusions: Continuous infusion of dexmedetomidine can decrease blood loss in orthognathic surgery.Trial registration number: ChiCTR1800018794 (retrospectively registered)Name of registry: Chinese Clinical Trial RegistryDate of registration: 2018/10/09URL: www.chictr.org.cn/showproj.aspx?proj=30612

Sudden bradycardia and impending cardiac arrest by intra-myometrial vasopressin in laparoscopic myomectomy: a case report and review of literature

Vasopressin has long been used in myomectomy to decrease blood loss. Its efficacy is beyond doubt. But at the same time it is known to cause some of the serious cardiovascular side effects. We here report a case of severe bradycardia and impending cardiac arrest caused by intra-myometrial infiltration of 12 U of vasopressin and present a review of literature.