The Management of Postoperative Bleeding

Dagi, T. Forcht

doi:10.1016/j.suc.2005.10.013

Cited by 28 publications

(28 citation statements)

References 18 publications

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“…Postoperative intra-abdominal bleeding is associated with significant morbidity and mortality 1. There are several hemostatic techniques, such as mechanical means, thermal devices, and topical hemostatic agents, for preventing postoperative hemorrhage 234.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Oxidized Regenerated Cellulose, SurgiGuard®, in Porcine Surgery

Kim

Yoon³

et al. 2017

Yonsei Med J

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PurposeAdequate hemostasis is important for postoperative outcomes of abdominal surgery. This study evaluated the hemostatic effects and accompanying histopathological changes of a novel oxidized regenerated cellulose, SurgiGuard®, during abdominal surgery.Materials and MethodsTen pigs underwent wedge resection of the spleen (1×1 cm) and liver (1.5×1.5 cm). The resected surface was covered with Surgicel® fabric or fibril type (Group A) or SurgiGuard® fabric or fibril type (Group B). Surgicel® and SurgiGuard® were randomized for attachment to the resected surface by fabric type (n=5) or fibril type (n=5). Blood loss was measured 5, 7, and 9 min after resection. Pigs were necropsied 6 weeks postoperatively to evaluate gross and histopathological changes.ResultsThere was no significant difference in total blood loss between groups [spleen fabric: Group A vs. Group B, 4.38 g (2.74–6.43) vs. 3.41 g (2.46–4.65), p=0.436; spleen fibril: Group A vs. Group B, 3.44 g (2.82–6.07) vs. 3.60 g (2.03–6.09), p=0.971; liver fabric: Group A vs. Group B, 4.51 g (2.67–10.61) vs. 6.93 g (3.09–9.95), p=0.796; liver fibril: Group A vs. Group B, 3.32 g (2.50–8.78) vs. 3.70 g (2.32–5.84), p=0.971]. Histopathological analysis revealed no significant difference in toxicities related to Surgicel® or SurgiGuard® [inflammation, fibrosis, foreign bodies, and hemorrhage (spleen: p=0.333, 0.127, 0.751, and 1.000; liver: p=0.155, 0.751, 1.000, and 1.000, respectively)].ConclusionSurgiGuard® is as effective and non-toxic as Surgicel® in achieving hemostasis after porcine abdominal surgery.

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Section: Introductionmentioning

confidence: 99%

Efficacy of Oxidized Regenerated Cellulose, SurgiGuard®, in Porcine Surgery

Kim

Yoon³

et al. 2017

Yonsei Med J

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“…For example, the risk of bleeding is increased in patients taking anticoagulants or antiplatelet agents, those with underlying intrinsic bleeding disorders, or those with specific comorbidities, including diabetes mellitus, hypertension, and renal insufficiency. 1,2 Further, primary complications of surgery, such as infection, can lead to the development of disseminated intravascular coagulation and widespread diffuse bleeding. 1 Iatrogenic factors, including poor surgical technique, hypothermia, acidosis, and hemodilution (infusion of large volumes of plasma-poor fluids) also contribute to the risk of perioperative bleeding.…”

mentioning

confidence: 99%

Achieving Hemostasis in the Surgical Field

Boucher

Traub

2009

Pharmacotherapy

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Hemostatic mechanisms are an integral part of the human physiology. Traditionally divided into intrinsic and extrinsic arms, the coagulation cascade converges, through the interactions of many different factors, at a common element-thrombin. As a consequence, a number of different agents have been developed to supplement this common, critical step to aid surgical hemostasis. Intraoperative interventions most commonly include sutures and heat-generating cautery devices; however, these methods are sometimes insufficient or inappropriate for a specific procedure or anatomic location, leading to the development of other adjunctive therapies, including topical hemostats. Topical hemostatic agents generally act as active, passive, and combinations therapies, depending on their individual composition and mode of action. We provide a brief review of the normal coagulation cascade, including critical points, followed by a discussion of surgical strategies and adjuctive therapies used to achieve surgical hemostasis and concluding with a discussion of topical thrombins.

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“…Patients who have high Child-Pugh class may have severe varicose collateral vessels, poor preoperative condition, severely enlarged spleen, and coagulation dysfunction, and these factors may cause massive intraoperative blood loss and necessitate blood product transfusion. 15 Other studies have shown that higher preoperative Child-Pugh class is an independent risk factor associated with massive intraoperative transfusion, and that Child-Pugh class A may be a protective factor for massive intraoperative bleeding after liver transplant. [25][26][27] In addition, preoperative international normalized ratio and presence of ascites may correlate independently with the amount of blood transfusion after liver transplant.…”

Section: Discussionmentioning

confidence: 98%

“…Massive blood loss during liver transplant may be associated with poor preoperative coagulation status, varicose collateral vessels, technical difficulties, or low preoperative platelet count. 15 Intraoperative massive blood loss may cause consumption of clotting factors, further compromising coagulation function in recipients. 16,17 This may explain the finding that massive intraoperative blood loss was a risk factor for postoperative bleeding after living-donor liver transplant (Table 4).…”

Section: Discussionmentioning

confidence: 99%