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Robotic Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Cela Vito, Braganti Francesca, Malacarne Elisa
Perioperative hemorrhage is the main risk associated with conservative myomectomy. Bleeding can be prevented or decreased using several techniques based on two main principles: reduction of uterine blood flow (use of cervical “tourniquet,” uterine artery ligation, or preoperative embolization) or use of uterotonic or vasoconstrictive agents (oxytocin, misoprostol or sulprostone, intramyometrial vasopressin, or epinephrine injection) [25]. Allogeneic blood transfusion can be avoided by using methods of intraoperative blood salvage and autologous blood transfusion.
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Her antenatal care should be managed by a multidisciplinary team consisting of a haematologist, an anaesthetist and an obstetrician with an interest in maternal medicine (1). She should be advised to take folic acid supplementation at 5 mg/day, and it is important to confirm she is taking penicillin V 250 mg b.d. (as hyposplenism is common) and that she is up to date with hepatitis B and pneumococcal vaccines (1). The maternal and fetal risks should be explained and the need for close monitoring during pregnancy emphasized (1). She should be encouraged to avoid dehydration and cold environments, as either may trigger a sickling crisis. If she suspects infection or an impending crisis, she should seek medical help urgently (1). Blood transfusion may be required, e.g. for severe anaemia, and exchange transfusion if the patient is volume replete. Exchange transfusion is controversial in pregnancy, so expert haematological advice is essential (1).
Blood Transfusion
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Blood transfusion involves the infusion of safe and compatible blood (or its components) from the donor to the recipient. Compatibility between donor red cell antigens and the plasma antibodies of the recipient should be ensured to avoid fatal haemolytic reactions.
Evaluation of efficacy and safety of intraoperative tranexamic acid: prospective placebo-controlled comparative study
Published in Egyptian Journal of Anaesthesia, 2022
Mohamed A. Lotfy, Samar A. Salman
Estimated intraoperative blood loss (IO-BL) was calculated using the Gross formula [13] where BL = BV [HCT (i) – HCT (f)], where BV (ml) is the calculated blood volume as body weight (kg) multiplied by 70 [14], HCT (i) and HCT (f) were the initial (preoperative) and final (postoperative) hematocrit values, respectively.Hemoglobin deficit was calculated as the difference between preoperative and immediate PO hemoglobin concentration (HBC).The frequency of blood transfusion and the number of transfused blood units were also determined, if required.
Characteristics of Nontrauma Patients Receiving Prehospital Blood Transfusion with the Same Triggers as Trauma Patients: A Retrospective Observational Cohort Study
Published in Prehospital Emergency Care, 2022
Susanne Ångerman, Hetti Kirves, Jouni Nurmi
Majority of the patients in both groups received blood transfusions in the hospital within 12 hours. However, it is possible that some patients were overtransfused due to the challenging diagnostics and decision-making in the prehospital setting. The shock index, acquired by dividing the heart rate by the systolic blood pressure, is an established and validated tool for identifying hemodynamically instable trauma patients (27, 28). It has recently been developed further to achieve more precise tools, such as modified shock index and age shock index (29). Furthermore, PHBT therapy could probably be targeted more precisely by analyzing point-of-care markers, such as lactate. In a study by Guyette et al., prehospital lactate outperformed shock index and systolic blood pressure in detection of resuscitative interventions in 387 trauma patients (30). The same physiological triggers may not be optimal in all age groups. In the current study, nontrauma patients were significantly older than trauma patients. This finding needs to be considered when evaluating the age-related transfusion criteria in the future.
Safety and efficacy of tranexamic acid in spinal canal tumors: a retrospective cohort study
Published in British Journal of Neurosurgery, 2020
Heng Zhu Zhang, Lun Dong, Huan Ming Wang, Fei Hu, Qiang Shao, Xu Chen, Lang Chen
There are many surgical methods for tumor resection in the spinal canal. Neurosurgeons aim to remove the entire tumor while maintaining the stability of the spine. Commonly available surgical approaches include laminectomy, hemilaminectomy, and the ‘archbone’ technique. The archbone technique1 is less traumatic as laminae and spinous processes are not separated from their muscle attachments, the average blood loss with this approach is 158 ml. Clinically, intraoperative blood loss may be great when removing some multi-segment, huge, spinal tumors, especially metastatic tumors. Although blood transfusions can be used to address this problem, they also pose potential risks, such as cross-infection and the spread of blood diseases.6 Elgafy et al.7 conducted a retrospective analysis of drugs used to reduce bleeding during spinal surgery over the past two decades. They found that TXA reduces the amount of bleeding during spine surgery and homologous blood transfusion. TXA is used for spinal deformity operations2 and thoracic fusion surgery in adult patients.8 There is evidence9 that TXA can reduce intraoperative bleeding.