Management of Perioperative Hemorrhage

Abstract

Uncontrollable bleeding is one of the most fearsome complications any surgeon may face. The most familiar procedure can rapidly deteriorate in a struggle for survival. However, careful preparation and a logical, reasoned approach to potential problems go a long way to alleviating this fear. PREOPERATIVE PREPARATIONA thorough history and physical examination will yield important information about the likelihood of perioperative bleeding problems. Prior hemorrhages after minor procedures such a tooth extraction, easy bruising, or particularly heavy menses may indicate an underlying disorder of coagulation. A family history of hemorrhagic or thrombotic complications should also be elicited.In general, routine laboratory screening of all patients in the absence of a history suggestive of bleeding problems adds unnecessary expense to the preoperative evaluation. In one study, prothrombin and partial thromboplastin times (PT/PTT) were normal in over 98% of patients without an antecedent bleeding history. Likewise, unsuspected thrombocytopenia is rare. For patients with a suspicious history, the standardized bleeding time is the single best test of the coagulation system; ABSTRACT Perioperative hemorrhage is a serious and potentially life-threatening complication. Adequate preoperative evaluation and management is crucial to avoiding problems. Good surgical technique with special attention to the spleen, pelvis, and anastomosis helps to minimize the risk of hemorrhage. Laparoscopic surgery adds additional limitations. Postoperative care helps to minimize the stress associated with intraoperative hemorrhage.

Complications of Anorectal Surgery

“…Fortunately, intraoperative bleeding during most anorectal cases is little more than a nuisance, easily controlled with the appropriate use of electrocautery or suture ligatures. 20 Proper 21,22 Bleeding occurs in a bimodal time frame, either immediately postoperatively or 7 to 10 days later. Early bleeding (within 24 hours) is usually the result of a technical error and usually will require return of the patient to the operating room where appropriate lighting, suction, and coagulation will allow surgical control of the bleeding site.…”