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Placental Disorders
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Daniele Di Mascio, Francesco D’Antonio
Labor and delivery staff (nursing and anesthesia), as well as the blood bank, should be notified regarding delivery plans. As suggested by the International Society for Abnormally Invasive Placenta, women with PAS should deliver in tertiary centers that could provide a multidisciplinary team with significant experience in managing PAS and that can provide antenatal diagnosis and preoperative planning; this team should be available 24 hours a day, 7 days a week, to ensure that expertise is available for emergency situations; the multidisciplinary team should, at a minimum, include an experienced obstetrician (often maternal-fetal medicine specialist), anesthesiologist with expertise in complex obstetric cases, surgeon experienced with complex pelvic surgery (often a gynecologic oncologist), urologist (with experience of open urologic surgery especially ureteric reimplantation), neonatologist, and interventional radiologist. There should be on-site, rapid access to the following in case of emergency: Colorectal surgeon, vascular surgeon, hematologist, adult intensive care facilities, NICU facilities, massive transfusion facilities, and intraoperative blood salvage (cell salvage) services [57].
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.
Bilateral Lobar Lung Transplantation with Extra-corporal Life Support (ECLS) in a Jehovah’s Witness
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Bastian Grande, Isabelle Opitz, Ilhan Inci
The 42-year-old woman suffering from a progressive interstitial lung disease presented to the University Hospital Zürich for lung transplantation listing process. Overall, she was a suitable candidate with a single organ failure. The lung function, the right heart function, and the preoperative blood and coagulation assessments met all criteria for lung transplantation. The aspect of the blood refusal had been discussed within the interdisciplinary lung transplantation team. Based on recent literature and our team experience, we accepted listing in this special case. The patient did not accept red blood cells, white blood cells, platelets, and plasma. She agreed to the use of normovolemic hemodilution, cardiopulmonary bypass (CPB), ECSL, intraoperative blood salvage with re-transfusion, and hemostatic agents including purified coagulation factor concentrates.
Oxidized Regenerated Cellulose Can Reduce Hidden Blood Loss after Total Hip Arthroplasty: A Retrospective Study
Published in Journal of Investigative Surgery, 2019
Ji-Qi Wang, Lu-Ying Chen, Bing-Jie Jiang, You-Ming Zhao
Many strategies to reduce HBL after THA can be implemented during the perioperative period and include acute normovolemic hemodilution, hypotensive anesthesia, and intraoperative blood salvage.7,8 However, these methods are time-consuming and expensive. Intravenous tranexamic acid during the operation,9 and drainage tube insertion and closure at certain time points after surgery,10 have been used to control postoperative HBL. However, it is important to note that tranexamic acid is a fibrinolytic inhibitor, and as such, increases the risk of deep vein thrombosis.11 Roth12 reported that drainage during primary THA conferred no benefit in terms of controlling postoperative bleeding, where considerable blood loss may still occur after surgery. Surgeons can also use adjunctive hemostats, which can enhance hemostasis perioperatively and have achieved good results.13
Pregnancy outcome after emergency uterine artery embolisation for management of intractable haemorrhage associated with laparoscopic-assisted myomectomy
Published in Journal of Obstetrics and Gynaecology, 2020
Akihiro Takeda, Wataru Koike, Shiori Tsuge, Mayu Shibata, Sanae Shinone, Hiromi Nakamura
Median surgical duration was 127 min, with median estimated blood loss of 950 mL. In addition to use of preoperatively pooled autologous blood in all cases, intraoperative blood salvage and donation were performed in six cases. Furthermore, packed red blood cells and fresh frozen plasma were administered in two cases. Although elongation of suprapubic incision to 4–5 cm was required in two cases, neither laparotomic conversion, which was defined as surgery with incision >10 cm, nor requirement of hysterectomy were experienced in the present case series.