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.

scholarly journals Effect of Intraoperative Blood Loss on Perioperative Complications and Neurological Outcome in Adult Patients Undergoing Elective Brain Tumor Surgery

2019 ◽  
Vol 10 (04) ◽  
pp. 631-640 ◽  
Author(s):  
Vanitha Rajagopalan ◽  
Rajendra Singh Chouhan ◽  
Mihir Prakash Pandia ◽  
Ritesh Lamsal ◽  
Girija Prasad Rath
Keyword(s):  
Brain Tumor ◽  
Blood Loss ◽  
Blood Volume ◽  
Perioperative Complications ◽  
Tumor Surgery ◽  
Intraoperative Blood Loss ◽  
Brain Tumor Surgery ◽  
Group A ◽  
Group B ◽  
Group D

Abstract Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20–50%), Group C (>50–100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender (p < 0.001), hypertension (p = 0.008), tumor size >5 cm (p < 0.001), high-grade glioma (p = 0.004), meningioma (p < 0.001), mass effect (p = 0.002), midline shift (p = 0.014), highly vascular tumors documented on preoperative imaging (p < 0.001), extended craniotomy approach (p = 0.002), intraoperative colloids use >1,000 mL (p < 0.001), intraoperative brain bulge (p = 0.03), intraoperative appearance as highly vascular tumor (p < 0.001), and duration of surgery >300 minutes (p < 0.001). Conclusions Knowledge of these predictors may help anesthesiologists anticipate major blood loss during brain tumor surgery and be prepared to mitigate these complications to improve patient outcome.

scholarly journals Optimization of antifibrinolytic protection during neurosurgical operations

2012 ◽  
Vol 93 (3) ◽  
pp. 438-442
Author(s):  
L R Sultanov
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Retrospective Analysis ◽  
Blood Volume ◽  
Postoperative Blood Loss ◽  
Intraoperative Blood Loss ◽  
Circulating Blood Volume ◽  
The Third ◽  
Brain And Spinal Cord ◽  
The Brain

Aim. To conduct a retrospective analysis of intraoperative and postoperative blood loss during removal of brain tumors with the usage of tranexamic acid and infusion correction of hemodynamically significant blood losses. Methods. The study included 139 patients operated on for tumors of the brain and spinal cord, and treated with tranexamic acid. Distribution of patients according to the volume of blood loss was as follows: the first group - up to 500 ml of blood loss, 48 patients (34.5%); the second group - 500-1200 ml of blood loss, 72 patients (51.7%); the third group - more than 1200 ml of blood loss, 19 patients (13.9%). Results. The retrospective analysis has shown that 34.5% of patients (first group) were operated with the lowest blood loss - up to 10% of the circulating blood volume; 51.7% of patients (second group) - with a blood loss of 20 to 30% of the circulating blood volume. In the third group, which included 13.9% of patients, there was a blood loss of more than 30% of the circulating blood volume, which is defined as hemodynamically significant. It is in the third group, as shown by the analysis, that in addition a therapeutic dose of tranexamic acid 15-20 mg/kg was administered. The extent and intensity of intraoperative blood loss were dependent on many factors, mainly on the nature of the tumor process. Conclusion. It was established that the changes of the hemostatic system were depended on the degree of hemodilution; the use of tranexamic acid made it possible to reduce the amount of postoperative blood loss, despite the degree of intraoperative blood loss.

scholarly journals CT Perfusion in Acute Stroke Predicts Final Infarct Volume- Inter-observer Study

2016 ◽  
Vol 43 (1) ◽  
pp. 93-97 ◽  
Author(s):  
Jai Jai Shiva Shankar ◽  
Gavin Langlands ◽  
Steve Doucette ◽  
Stephen Phillips
Keyword(s):  
Computed Tomography ◽  
Medical Student ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Kappa Statistics ◽  
Lesion Volume

AbstractBackground: Computed tomography perfusion (CTP) is increasingly being used in the setting of acute ischemic stroke (AIS). The aim of the current study was to compare the prognostic utility of, and inter-observer variation between, baseline appearances on non-contrast CT (using Alberta Stroke Program Early CT score(ASPECTS)) and on CTP for predicting final infarct volume. We also assessed impact of training on interpretation of these images. Methods: Retrospectively, plain head computed tomography (CT) and CTP images at presentation and CT or diffusion imaging on follow up of patients with AIS were analyzed. The lesion volume on different CTP parameters was then correlated with the final infarct volume. This analysis was done by a Neuroradiologist, a stroke Neurologist and a medical student. Kappa statistics and Intra-class correlation coefficients were used for agreement between readers. Pearson correlation coefficients were used.Results: Thirty eight patients with AIS met all inclusion criteria. There was very good agreement among all readers for the CTP parameters. There was only fair agreement for ASPECT score. Correlation coefficient (r-square) between CTP parameters and final infarct volume showed that cerebral blood volume was the best parameter to predict the final infarct volume followed by cerebral blood flow and time to peak. The best reader to predict the final infarct volume on the initial CT perfusion study was the neuroradiologist followed by medical student and stroke neurologist. Conclusions: Cerebral blood volume defect correlated the best with the final infarct volume. There was a very good inter-observer agreement for all the CTP maps in predicting the final infarct volume despite the wide variation in the experience of the readers.

Intraoperative Transpedicular Onyx Injection to Reduce Vascularity of a Thoracic Hemangiopericytoma After Unsuccessful Preoperative Endovascular Embolization: a Technical Report

2017 ◽  
Vol 14 (2) ◽  
pp. E17-E22
Author(s):  
Hazem Mashaly ◽  
Zoe Zhang ◽  
Andrew Shaw ◽  
Patrick Youssef ◽  
Ehud Mendel
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Blood Loss ◽  
Surgical Resection ◽  
Central Nervous System Involvement ◽  
Vascular Tumor ◽  
Massive Bleeding ◽  
Endovascular Embolization ◽  
Intraoperative Blood Loss ◽  
Percutaneous Injection

Abstract BACKGROUND AND IMPORTANCE Hemangiopericytoma is a rare vascular tumor with central nervous system involvement representing only 1% of central nervous system tumors. They rarely affect the vertebral column. Complete surgical resection is the treatment of choice for hemangiopericytoma given their high rates of local recurrence. However, the high vascularity of such tumors with the risk of massive bleeding during surgery represents a significant challenge to surgeons. Therefore, preoperative endovascular embolization via the transarterial route has been advocated. CLINICAL PRESENTATION In the current study, we present a case of a T12 hemangiopericytoma that was managed by a 2-stage surgical resection, with the use of intraoperative transpedicular onyx injection to reduce intraoperative blood loss following an unsuccessful trial of preoperative endovascular embolization. CONCLUSION Preoperative endovascular embolization is not feasible in some cases due to the location of the segmental or radiculomedullary arteries in relation to tumor feeders and, rarely, small size of these arterial feeders. Percutaneous injection of onyx is an option. In this case report, we discuss direct intraoperative injection via a transpedicular route as a safe and effective method for decreasing the vascularity of some lesions and improving intraoperative blood loss.

scholarly journals The effect of body mass index on blood loss and complications in simultaneous bilateral total hip arthroplasty: A multicenter retrospective study

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110612
Author(s):  
Guorui Cao ◽  
Xiuli Yang ◽  
Chen Yue ◽  
Honglue Tan ◽  
Hong Xu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Blood Loss ◽  
Blood Volume ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Obese Group ◽  
Transfusion Rate ◽  
Intraoperative Blood Loss

Background The effect of body mass index (BMI) on blood loss in simultaneous bilateral total hip arthroplasty (SBTHA) was still undetermined. The purpose of the study was to evaluate the blood loss, transfusion and incidence of complications in normal, overweight, and obese patients undergoing SBTHA. Methods A total of 344 patients following SBTHA were enrolled into this study. The patients were assigned into three groups on the basis of their BMI, including normal (BMI 18.0–24.9 kg/ [Formula: see text]), overweight (BMI 25.0–29.9 kg/ [Formula: see text]), or obese group (BMI ≥ 30.0 kg/ [Formula: see text]). The primary outcome was total blood loss (TBL), and secondary outcomes were intraoperative blood loss, drain volume, ratio of TBL and patient’s blood volume (PBV), transfusion rate and volume, hemoglobin and hematocrit drop, length of stay, expenses, and complications. Results The PBV and TBL increased significantly along with the elevated BMI ( p < 0.001; p = 0.019, respectively). There was no significant difference in intraoperative blood loss, drain volume, transfusion volume, length of stay, expenses, or incidence of complications among the three groups. In addition, the transfusion rate in normal group was higher than that in overweight (58.3% vs 39.6%, p = 0.001) and obese group (58.3% vs 31.9%, p = 0.001). The maximum hemoglobin drop in obese group was the highest ( p = 0.001). Conclusion Obesity could increase perioperative blood loss but not increase transfusion risk in the setting of SBTHA. Conversely, obese and overweight patients maybe have lower transfusion need compared with normal patients because of more blood volume. In addition, obesity did not affect the incidence of complications.

Preoperative Fibrin Monomer Allows Prediction on Excessive Intraoperative Blood Loss - Finally a Preoperative Coagulation Screening That Works?.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1034-1034
Author(s):  
Wolfgang C. Korte ◽  
Patrick Wettstein ◽  
Konrad Gabi ◽  
Mirjam Rohner ◽  
Cinzia Corbetta ◽  
...  
Keyword(s):  
Blood Loss ◽  
Roc Curve ◽  
Area Under The Curve ◽  
Monomer Concentration ◽  
Accuracy Evaluation ◽  
Risk Indicator ◽  
Intraoperative Blood Loss ◽  
Surgical Service ◽  
Fibrin Monomer ◽  
The One

Abstract We recently demonstrated that patients with intraoperative coagulopathy and increased blood loss show a persistent pre-, intra- and postoperative increase in fibrin monomer concentration as well as an excessive intraoperative consumption of fibrinogen and F. XIII. We therefore wanted to test the hypothesis that preoperative fibrin monomer concentrations can be used as a risk indicator for intraoperative blood loss. In 168 patients admitted to the surgical service of our hospital, median intraoperative blood loss increased significantly with preoperative fibrin monomer (FM) quartiles (50, 100, 200 and 400 ml in preoperative FM quartiles 1 to 4; p&lt;0.001, ANOVA on ranks and p&lt;0.05 for group wise comparison, Rank Sum test). Stratification in FM quartile groups was unrelated to diagnoses with the exception of laparoscopic cholecystectomy (found significantly less frequent in quartile 4 than 1). Most importantly, accuracy evaluation showed that preoperative fibrin monomer concentration &lt; 3 μg/l excluded intraoperative blood loss &gt; 500 ml with 92% sensitivity, 95% negative predictive value and 41% exclusion rate. This compares well to other exclusion strategies such as the exclusion of deep venous thrombosis with the help of D-dimer and probability scores. In contrast, blood loss was unrelated to preoperative values of prothrombin time, platelet count and actived partial thromboplastin time. The FM ROC curve compared to the PT ROC curve is shown in the figure; the area under the curve for the FM ROC curve was significantly greater than the one for the PT ROC curve (0.743, 95% CI 0.655 – 0.811 vs. 0.555, 95% CI 0.473 – 0.635). These results - obtained in a second, independent and prospective study - confirm the hypothesis generated from our first study that preoperative fibrin monomer concentrations allow prediction on excessive intraoperative blood loss. We suggest that preoperative fibrin monomer concentrations be further studied for identification of patients that might benefit from intensified intraoperative monitoring. Figure Figure

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).

scholarly journals Direct Cost of Anesthesia in Traumatic Patients with Massive Bleeding: a Prospective Micro-Costing Study

2021 ◽  
Vol 1 (1) ◽  
pp. 9-16
Author(s):  
Asamaporn Puetpaiboon ◽  
Sunisa Chatmongkolchart ◽  
Osaree Akaraborworn ◽  
Yupin Apisitthiwong
Keyword(s):  
Blood Loss ◽  
Blood Volume ◽  
Direct Cost ◽  
Labor Cost ◽  
Massive Bleeding ◽  
Charge Ratio ◽  
Operating Table ◽  
Anesthetic Care ◽  
Estimated Blood Loss ◽  
The Cost

Objective:This study aimed to quantify the direct cost as well as cost-to-charge ratio of anesthetic care in traumatic patients with intraoperative massive bleeding.Material and Methods: This study was a prospective observational cost analysis study, conducted in Songklanagarind Hospital, Thailand. Traumatic patients from any mechanisms were recruited. Massive bleeding was defined as estimated blood loss of at least one blood volume in 24 hours or a half of blood volume in 3 hours. The cost components were valued by the bottom-up approach. The direct cost was divided into 4 categories; the labor cost, the capital cost, the material cost and the cost of drugs.Results: From September 2017 to August 2018; 10 eligible patients were included. Seven patients had motorcycle accidents, two patients fell from height and another one was in a minibus accident. Two patients died on the operating table, and another two died within 48 hours. The median direct cost per case was 9,321 Baht (264 United States Dollars), and the cost-to-charge ratio was 0.62. The median Sequential Organ Failure Assessment Score was 8. The median intraoperative blood loss was 3,500 millimeters.Conclusion: Our study provided information on the direct costs of anesthesia in traumatic patients with massive bleeding. The direct cost was 62.0% of the hospital charge. However, this study did not analyze the indirect cost.

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