No abstract

Bleeding is a frequent complication during surgery. The intraoperative administration of blood products, including packed red blood cells, platelets and fresh frozen plasma (FFP), is often life saving. Complications of blood transfusions contribute considerably to perioperative costs and blood product resources are limited. The aim of the present study was to evaluate and compare the usage of INR guided vs clinician discretion based component replacement therapy which will optimize the use of FFP and may even result in less blood loss during surgery. Materials and Method: This study was conducted in surgical patients in a large tertiary care centre. Ethical clearance was taken from the local ethics committee at the proposal stage itself. Patients consent was taken after providing all necessary information prior to surgery. This study was conducted on 200 patients. The groups were randomised to two groups of Gp 1-study (S) -100 patients (point of care based transfusion management) Gp 2control (C)-100 patients (physician discretion based management). After premedication with intravenous morphine (0.05-0.1 mg/kg body weight), Glycopyrrolate and ondansetron, General anaesthesia was induced with thiopentone sodium. Endotracheal intubation Intubation achieved after vecuronium. Anesthesia was maintained using low flow nitrous oxide: oxygen mixture (fresh gas flow of 1ltr each) and Isoflurane (1 MAC) via a closed circuit cycle absorber system and mechanical ventilation with 5 -10 ml/kg. Standard monitoring will include HR, ECG (two lead), blood pressure (NIBP/ IABP), SpO2, Naso pharyngeal temperature. Patient warming was done with warm air blower (with a target temp above 36 0 C). In the control group physician discretion was used to guide Blood platelet or FFP transfusion based on the institutional protocol. These are blood if Hb <8 gm %, platelets if <50,000 or between 50,000-80,000 with ongoing blood loss and FFP if bleeding >20% or >2 units blood given and repeated if physician desires. However these are guidelines and physician discretion based on clinical judgment is freely allowed. In the test group if bleeding is estimated to be more than 205 CBC and POC INR is done. If Hb < 8 gm % blood is transfused, if platelets <50,000 then 1 Single Donor Platelets or 6 Random Donor Platelets are transfused. 2 units of FFP are transfused if POC INR >1.8. Test was repeated after 30mins and 2 more units of FFP was given if INR >1.5. Result: there was no difference in age distribution sex weight of pateints between the t wo group, however the need for blood component therapy was in higher in pateints who were treated based on clinical discretion compared to INR guided treatment. The mean duration of post-operative ventilation required for the patient to be extubated with stable haemodynamic parameters in the test group was 48.55 hrs compared to 78.4 hrs for the control group. The maximum duration of post-operative ventilation in test group was 212 hrs, compared to 281 hrs for the control group. While the minimum duration was com...

Objective Perioperative shivering is a very common complication. Despite the vast array of knowledge regarding perioperative shivering and its after-effects, its prophylaxis is often overlooked. The study aims to compare the efficacy and safety of low-dose ketamine, ondansetron, and pethidine in the prevention of perioperative shivering in patients undergoing total knee replacement surgery under the subarachnoid block. Methods In this randomized controlled study, 203 patients aged 18-75 were included and allocated to one of the 4 groups; normal saline (group S), ondansetron 4 mg (group O), ketamine 0.25 mg kg −1 (group K), and pethidine 0.25 mg kg −1 (group P). Side effects, namely hypotension, nausea and vomiting, sedation, hallucinations, and respiratory depression were recorded. Results Perioperative shivering was present in 22 (44%), 8 (16%), 4 (7.84%), and 4 (7.69%) patients respectively in group S, O, K, and P, which was statistically significant when compared to group S with group K and P ( P < .01). No difference in the incidence of hypothermia was observed across the groups ( P < .17). A significantly lower incidence of hypotension was observed in group K. In group K, 5.9% of the patients were scored as being under severe sedation, according to the modified Wilson sedation scale. There was no incidence of hallucination or respiratory depression observed in any of the groups. Conclusions Patients undergoing total knee replacement surgeries are highly predisposed to the development of hypothermia. Temperature monitoring is thus imperative for all patients. Prophylactic administration of low-dose ketamine or ondansetron or low-dose pethidine produces a significant anti-shivering effect without any significant side effects. However, low-dose ketamine has the advantages of a lower incidence of hypotension, nausea, and vomiting than pethidine.