scholarly journals Intraoperative blood loss may be associated with myocardial injury after non-cardiac surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0241114
Author(s):  
Jungchan Park ◽  
Ji-hye Kwon ◽  
Seung-Hwa Lee ◽  
Jong Hwan Lee ◽  
Jeong Jin Min ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Myocardial Injury ◽  
Area Under The Curve ◽  
Hemoglobin Level ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding ◽  
Inverse Probability ◽  
Red Cell Transfusion ◽  
Patient Enrollment

Background This study aimed to evaluate the association between intraoperative blood loss and myocardial injury after non-cardiac surgery (MINS), which is a severe and common postoperative complication. Methods We compared the incidence of MINS based on significant intraoperative bleeding, defined as an absolute hemoglobin level < 7 g/dL, a relative hemoglobin level less than 50% of the preoperative measurement, or need for packed red cell transfusion. We also estimated a threshold for intraoperative hemoglobin level associated with MINS. Results We stratified a total of 15,926 non-cardiac surgical patients with intraoperative hemoglobin and postoperative cardiac troponin (cTn) measurements according to the occurrence of significant intraoperative bleeding; 13,416 (84.2%) had no significant bleeding while 2,510 (15.8%) did have significant bleeding. After an adjustment with inverse probability weighting, the incidence of MINS was higher in the significant bleeding group (35.2% vs. 16.4%; odds ratio, 1.58; 95% confidence interval, 1.43–1.75; p < 0.001). The threshold of intraoperative hemoglobin associated with MINS was estimated to be 9.9 g/dL with an area under the curve of 0.643. Conclusion Intraoperative blood loss appeared to be associated with MINS. Further studies are needed to confirm these findings. Clinical registration The cohort was registered before patient enrollment at https://cris.nih.go.kr (KCT0004244).

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 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.

scholarly journals Preoperative cephalhematoma size measured with computed tomography predicts intraoperative bleeding in pediatric patients undergoing cranioplasty

2021 ◽  
Author(s):  
Seung Hyun Kim ◽  
Kyeong Tae Min ◽  
Eun Kyung Park ◽  
Hyungjin Rhee ◽  
Hyukjin Yang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Blood Loss ◽  
Blood Volume ◽  
Pediatric Patients ◽  
Pearson Correlation ◽  
Area Under The Curve ◽  
Massive Bleeding ◽  
Multivariable Logistic Regression Analysis ◽  
Intraoperative Blood Loss ◽  
Receiver Operating Characteristic Plot

Background: Cranioplasty for the treatment of cephalhematomas in small infants with limited blood volume is challenging because of massive bleeding. This study aimed to elucidate the correlation between cephalhematoma size and intraoperative blood loss and identify criteria that can predict large intraoperative blood loss.Methods: We reviewed the medical records of 120 pediatric patients aged less than 24 months who underwent cranioplasty for treatment of a cephalhematoma. The cephalhematoma sizes in preoperative brain computed tomography (CT) were measured using ImageJ. Results: Pearson correlation showed that the cephalhematoma size in the pre-operative brain CT was weakly correlated with intraoperative blood loss (Pearson coefficient = 0.192, P = 0.037). In a multivariable logistic regression analysis, a cephalhematoma size greater than 113.5 cm3 was found to be a risk factor for large blood loss. The area under the curve in the receiver operating characteristic plot of the multivariable model was 0.714 (0.619–0.809).Conclusions: A cephalhematoma size cutoff value of 113.5 cm3, as measured in the preoperative CT imaging, can predict intraoperative blood loss exceeding 30% of the total body blood volume. The establishment of a transfusion strategy prior to surgery based on cephalhematoma size could be useful in pediatric cranioplasty.

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 Comparison of pre- and postoperative myocardial injuries on mortality after non-cardiac surgery: a retrospective analysis using an inverse probability weighting adjustment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Seung-Hwa Lee ◽  
Jungchan Park ◽  
Jong-Hwan Lee ◽  
Jeong Jin Min ◽  
Kwan Young Hong ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Postoperative Mortality ◽  
Inverse Probability Weighting ◽  
Similar Degree ◽  
Probability Weighting ◽  
Inverse Probability ◽  
Injury Group ◽  
Myocardial Injuries

AbstractAlthough both pre- and postoperative myocardial injuries are strongly associated with an increased postoperative mortality, no study has directly compared the effects of pre- and postoperative myocardial injuries on 30-day mortality after non-cardiac surgery. Therefore, we evaluated and compared the effects of pre- and postoperative myocardial injury on 30-day mortality after non-cardiac surgery. From January 2010 to December 2016, patients undergoing non-cardiac surgery were stratified into either the normal (n = 3182), preoperative myocardial injury (n = 694), or postoperative myocardial injury (n = 756) groups according to the peak cardiac troponin value. Myocardial injury was defined as a sole elevation of cardiac troponin value above the 99th percentile upper reference limit without ischemic symptom using the 4th universal definition of myocardial infarction. Patients in the preoperative myocardial injury group were further divided into the attenuated (n = 177) or persistent myocardial injury group (n = 517) according to the normalization of cardiac troponin level in postoperative period. As the primary outcome, postoperative 30-day mortalities were compared among the groups using the weighted Cox proportional-hazards regression models with the inverse probability weighting. Compared with the normal group, postoperative 30-day mortality was increased significantly both in the pre- and postoperative myocardial injury groups (1.4% vs. 10.7%; hazard ratio [HR] 3.12; 95% confidence interval [CI] 1.62–6.01; p = 0.001 and 1.4% vs. 7.4%; HR 4.49; 95% CI 2.34–8.60; p < 0.001, respectively), however, there was no difference between the pre- and postoperative myocardial injury groups (HR, 1.44; 95% CI 0.79–2.64; p = 0.45). In addition, the attenuated myocardial injury group showed a significantly lower postoperative 30-day mortality than the persistent myocardial injury group (5.6% vs. 12.4%; HR 2.23; 95% CI 1.17–4.44; p = 0.02). In patients undergoing non-cardiac surgery, preoperative myocardial injury also increased postoperative 30-day mortality to a similar degree of postoperative myocardial injury. Further studies on the importance of preoperative myocardial injury are needed.Clinical trial number and registry URL: KCT0004348 (www.cris.nih.go.kr).

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.

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