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An Adjusted Calculation Model Allows for Reduced Protamine Doses without Increasing Blood Loss in Cardiac Surgery.

https://arctichealth.org/en/permalink/ahliterature284260
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Publication Type
Article
Date
Sep-2016
Author
Gunilla Kjellberg
Ulrik Sartipy
Jan van der Linden
Emelie Nissborg
Gabriella Lindvall
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - administration & dosage - adverse effects
Blood Coagulation - drug effects
Blood Coagulation Tests
Blood Loss, Surgical - prevention & control
Body Height
Body Weight
Cardiac Surgical Procedures - adverse effects
Cardiopulmonary Bypass - adverse effects
Computer simulation
Drug Dosage Calculations
Female
Heparin - administration & dosage - adverse effects
Heparin Antagonists - administration & dosage - adverse effects
Humans
Male
Middle Aged
Models, Biological
Postoperative Hemorrhage - etiology - prevention & control
Protamines - administration & dosage - adverse effects
Sweden
Time Factors
Treatment Outcome
Abstract
Background Heparin dosage for anticoagulation during cardiopulmonary bypass (CPB) is commonly calculated based on the patient's body weight. The protamine-heparin ratio used for heparin reversal varies widely among institutions (0.7-1.3?mg protamine/100 IU heparin). Excess protamine may impair coagulation. With an empirically developed algorithm, the HeProCalc program, heparin, and protamine doses are calculated during the procedure. The primary aim was to investigate whether HeProCalc-based dosage of heparin could reduce protamine use compared with traditional dosages. The secondary aim was to investigate whether HeProCalc-based dosage of protamine affected postoperative bleeding. Patients and Methods We consecutively randomized 40 patients into two groups. In the control group, traditional heparin and protamine doses, based on body weight alone, were given. In the treatment group, the HeProCalc program was used, which calculated the initial heparin bolus dose from weight, height, and baseline activated clotting time and the protamine dose at termination of CPB. Results We analyzed the results from 37 patients, after exclusion of three patients. Equal doses of heparin were given in both groups, whereas significantly lower mean doses of protamine were given in the treatment group versus control group (211?±?56 vs. 330?±?61?mg, p?
PubMed ID
26270199 View in PubMed
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Is oxytocin given during surgical termination of first trimester pregnancy useful? A randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature137855
Source
Acta Obstet Gynecol Scand. 2011 Feb;90(2):174-8
Publication Type
Article
Date
Feb-2011
Author
Ingerid Helene Herstad Nygaard
Annelill Valbø
Helene Christine Heide
Milena Kresovic
Author Affiliation
Department of Gynecology and Obstetrics, Asker and Baerum Hospital, Norway. IngeridHeleneHerstad.Nygaard@vestreviken.no
Source
Acta Obstet Gynecol Scand. 2011 Feb;90(2):174-8
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Abortifacient Agents, Nonsteroidal
Abortion, Induced - adverse effects
Adult
Female
Follow-Up Studies
Humans
Nausea - etiology - prevention & control
Norway
Oxytocics
Oxytocin
Pain, Postoperative - etiology - prevention & control
Postoperative Hemorrhage - etiology - prevention & control
Pregnancy
Pregnancy Trimester, First
Single-Blind Method
Treatment Outcome
Abstract
To compare the impact of 5 IU (international units) of oxytocin administered during surgical termination of first-trimester pregnancy compared to no oxytocin, on postoperative bleeding, pain and nausea.
A randomized controlled single-blinded study.
A Norwegian community hospital with 1,064 consecutive legal abortions in the 20 months of study period.
A total of 378 women undergoing surgical termination of first-trimester pregnancy and willing to participate in the study.
Women were randomized into two groups: Group 1, receiving a standard procedure of 5 IU of oxytocin during the surgical procedure, or Group 2, receiving no oxytocic agent. All women had preoperative misoprostol.
Vaginal bleeding, pain and nausea recorded by weighing pads immediately after the surgical procedure and counting pads during the three following days.
No significant differences between the two groups could be demonstrated with regard to the recorded postoperative blood loss, pain and nausea.
The standard routine of administering oxytocin during surgical termination of first-trimester pregnancy should be revised.
PubMed ID
21241263 View in PubMed
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Oral surgery in liver transplant candidates: a retrospective study on delayed bleeding and other complications.

https://arctichealth.org/en/permalink/ahliterature279114
Source
Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):490-5
Publication Type
Article
Date
May-2016
Author
Jaana Helenius-Hietala
Fredrik Åberg
Jukka H Meurman
Arno Nordin
Helena Isoniemi
Source
Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):490-5
Date
May-2016
Language
English
Publication Type
Article
Keywords
Blood Transfusion
Female
Finland
Hemostasis, Surgical
Hemostatics - therapeutic use
Humans
International Normalized Ratio
Liver Transplantation
Male
Middle Aged
Oral Hemorrhage - etiology - prevention & control
Oral Surgical Procedures
Platelet Count
Postoperative Hemorrhage - etiology - prevention & control
Predictive value of tests
Retrospective Studies
Risk factors
Time Factors
Tooth Extraction
Abstract
Untreated dental infections pose a threat for immunocompromised liver transplant (LT) recipients. Therefore, pretransplant dental evaluations are recommended. However, risk of bleeding should be considered among patients with end-stage liver disease, and prophylactic blood transfusions may be used to prevent bleeding. We performed a retrospective study of the incidence of and risk factors for oral surgery-related bleeding in candidates for LT and hypothesized that complications may occur despite preoperative and perioperative hemostatic actions.
One hundred thirty-four patients who had tooth extractions performed by oral and maxillofacial surgeons before LT were studied. The primary endpoint was bleeding between 24 hours and 2 weeks after extraction. Bleeding risk was analyzed by preoperative platelet (PLT) count and international normalized ratio (INR). Invasiveness of procedures, severity of liver disease, PLT, INR, prophylactic transfusions of PLT, fresh frozen plasma, and tranexamic acid (TA) were included in univariate and multivariate logistic regression analyses to further assess risk.
Twelve patients exhibited minor bleeding; four despite PLT >100 × 10(9)/L and INR
PubMed ID
27068309 View in PubMed
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Post-tonsillectomy hemorrhage: assessment of risk factors with special attention to introduction of coblation technique.

https://arctichealth.org/en/permalink/ahliterature91499
Source
Eur Arch Otorhinolaryngol. 2009 Jul;266(7):1011-5
Publication Type
Article
Date
Jul-2009
Author
Heidemann Christian H
Wallén Mia
Aakesson Marie
Skov Peter
Kjeldsen Anette D
Godballe Christian
Author Affiliation
Department of ENT, Head and Neck Surgery, Odense University Hospital, 5000, Odense C, Denmark. chrheidemann@gmail.com
Source
Eur Arch Otorhinolaryngol. 2009 Jul;266(7):1011-5
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cohort Studies
Electrocoagulation - adverse effects
Female
Hemostasis, Surgical
Humans
Infant
Male
Middle Aged
Palatine Tonsil - surgery
Postoperative Hemorrhage - etiology - prevention & control
Retrospective Studies
Risk factors
Tonsillectomy - adverse effects - methods
Young Adult
Abstract
Post-tonsillectomy hemorrhage (PTH) is a relatively common and potentially life-threatening complication. The objective of this study was to examine the rate of PTH and identify risk factors. A retrospective cohort study was carried out including all tonsillectomies (430 patients) performed at Odense University Hospital (OUH) or Svendborg Hospital (SH), Denmark. PTH occurred in 52 patients (12.1%). Of the 180 patients treated with coblation technique, 41 (22.7%) had PTH. There were no fatal bleeding episodes. Multiple regression analysis resulted in three significant covariates: "Coblation as surgical technique" [relative risk (RR) = 5.3], "peritonsillar abscess as indication for surgery" (RR = 0.3) and "age equal to or above 15 years at the time of surgery" (RR = 5.4). It is concluded that patient age, PTA as indication for surgery and the use of coblation significantly affect the occurrence of PTH when coblation procedures are performed by non-experienced surgeons. We advise that implementation of coblation tonsillectomy is thoroughly planned with sufficient training of surgeons and continuous surveillance of results. If PTH rates comparable to "cold dissections tonsillectomy" cannot be reached intervention (learning or closing down of coblation tonsillectomy) has to be done.
PubMed ID
18953553 View in PubMed
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