BackgroundOutcome data for the great majority of liver normothermic machine perfusion (NMP) cases derive from the strict confines of clinical trials. Detailed specifics regarding the intraoperative and early postoperative impact of NMP on reperfusion injury and its sequelae during real‐world use of this emerging technology remain largely unavailable.MethodsWe analyzed transplants performed in a 3‐month pilot period during which surgeons invoked commercial NMP at their discretion. Living donor, multi‐organ, and hypothermic machine perfusion transplants were excluded.ResultsIntraoperatively, NMP (n = 24) compared to static cold storage (n = 25) recipients required less peri‐reperfusion bolus epinephrine (0 vs. 60 μg; p < .001) and post‐reperfusion fresh frozen plasma (2.5 vs. 7.0 units; p = .0069), platelets (.0 vs. 2.0 units; p = .042), and hemostatic agents (0% vs. 24%; p = .010). Time from incision to venous reperfusion did not differ (3.6 vs. 3.1; p = .095) but time from venous reperfusion to surgery end was shorter for NMP recipients (2.3 vs. 2.8 h; p = .0045). Postoperatively, NMP recipients required fewer red blood cell (1.0 vs. 4.0 units; p = .0083) and fresh frozen plasma (4.0 vs. 7.0 units; p = .046) transfusions, had shorter intensive care unit stays (33.5 vs. 58.4 h; p = .012), and experienced less early allograft dysfunction according to both the Model for Early Allograft Function Score (3.4 vs. 5.0; p = .0047) and peak AST within 10 days of transplant (619 vs. 1,181 U/L; p = .036). Liver acceptance for the corresponding recipient was conditional on NMP use for 63% (15/24) of cases.ConclusionReal‐world NMP use was associated with significantly lower intensity of reperfusion injury and intraoperative and postoperative care that may translate into patient benefit.

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It has been known for a long time that clinical symptoms and signs are of little help in the diagnosis of venous thrombosis of the legs because they lack both sensitivity and specificity. This applies to calf tenderness, pain on dorsiflexion of the foot (the Homan's sign), increased skin temperature, ankle and calf edema, and superficial venous dilatation. Contrast venography, the first objective test and still the gold standard in the diagnosis of venous thrombosis. This clinical prospective study on Efficacy of Enoxaparin as a Thromboprophylactic agent in major lower limb orthopedic surgeries was conducted in department of Orthopedics. During the study period, 180 patients undergoing Surgeries for fracture around hip, femur fracture surgery, patients undergoing Hip and Knee Arthroplasty were given prophylaxis for DVT.A prior consent was obtained from all the patients and the study was approved by the Ethical Committee of the Hospital. The Youngest patient in this study was 20 years and oldest 85 years of age. The average age being 54 years.43.3% of patients were 60 and above, 21.11% between 50-59, 16.11% between 40-49, 9.44% between 30-39 and 10% between 20-29 years of age. Indications for Hemiarthroplasties were fracture neck of femur in forty two cases. Total Hip Replacement was done in six cases, three of them had avascular necrosis of head of femur and three of them had secondary arthritis of hip. Total Knee Replacement for primary osteoarthritis was done in twenty four cases.

Venous Thromboembolism (VTE) which consists of Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE) is a potentially fatal & common complication following major lower limb orthopaedic surgeries like Hip, Knee Arthroplasty & Hip fracture surgeries which fall under highest risk category for VTE stratification. Analysis of selected Indian articles show that rates of DVT with prophylaxis is 8% and without prophylaxis 14%. Therefore VTE prophylaxis is essential to prevent the mortality and morbidity associated with it. Low Molecular weight heparins like Enoxaparin is one of the leading anticoagulants registered for use worldwide and has a long track record of over several years for safety and efficiency in orthopaedic surgeries. 180 patients undergoing Surgeries for fracture around Hip, Femur fracture surgery, patients undergoing Hip and Knee Arthroplasty were given prophylaxis for DVT in the form of Inj. Enoxaparin 40 Mg S/C once a day for 10 days starting 12 hours after epidural catheter removal. Three Bilateral lower limb venous Doppler scans were done in all the patients, one at the time of admission, one on eleventh post op day and another on thirtieth post-operative day to look for development or progression of deep vein thrombosis. Only One Patient (0.55%) showed ultrasonographic evidence of proximal asymptomatic Deep Vein Thrombosis on the eleventh post-operative day. Patient was treated for the same and the thrombus resolved while on treatment as shown by repeat Doppler scan done on twentieth day following detection. No cases of Fatal Pulmonary embolism or major complications were noted in the study. Enoxaparin is a safe and effective thromboprophylactic agent when used for the duration of 10 days post operatively in Major lower Limb orthopaedic Surgeries.