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Magaldi M, de Santos P, Basora M. Patient Blood Management en ginecología. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Luis C, Pardo A, Moreno CE, Teixell C, Santiveri X, Bisbe E. Clinical trial to determine whether the timing of tranexamic acid administration influences perioperative bleeding in total knee arthroplasty. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:517-525. [PMID: 36241511 DOI: 10.1016/j.redare.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/18/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The ideal timing of tranexamic acid administration in total knee arthroplasty with tourniquet remains unclear. Our primary objective was to prove if administering it before surgical incision, instead of before releasing the tourniquet, reduces postoperative bleeding. A second objective was to determine whether a second dose reduces post-operative bleeding. MATERIAL AND METHODS A prospective, double-blind clinical trial was performed on 212 patients scheduled for total knee arthroplasty. They were randomised into 4 groups. Tranexamic acid was administered before the surgical incision in "pre-induction groups" (1 and 2), and just before the tourniquet release in "pre-release groups" (3 and 4). Groups 2 and 4 received a second dose 3h post-surgery. Main outcome was postoperative bleeding (visible blood loss and calculated total bleeding). Secondary outcomes were haemoglobin variations, complications and transfusion rate. RESULTS The mean calculated total bleeding was 1563ml (95%CI: 1445-1681) in preinduction groups versus 1576ml (95%CI: 1439-1713) in pre-release groups (P=0.9); 1579ml (95%CI: 1452-1706) in single-dose groups versus 1559ml (95%CI: 1431-1686) in double-dose groups (P=0.82). One patient was transfused. The mean haemoglobin at discharge was 10.4g/dl (95%CI: 10.2-10.7) in singledose groups versus 10.8 (95%CI: 10.6-11.1) in double-dose groups (P=0.06). CONCLUSIONS There were no differences in bleeding or transfusion regarding the time of tranexamic acid administration. The second dose had not impact on outcomes. TRIAL REGISTRATION EudraCT 2016-000071-24.
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Affiliation(s)
- C Luis
- Departamento de Anestesiología, Hospital del Mar, Barcelona, Spain.
| | - A Pardo
- Departamento de Anestesiología, Hospital del Mar, Barcelona, Spain
| | - C E Moreno
- Departamento de Anestesiología, Hospital del Mar, Barcelona, Spain
| | - C Teixell
- Departamento de Anestesiología, Hospital del Mar, Barcelona, Spain
| | - X Santiveri
- Departamento de Anestesiología, Hospital del Mar, Barcelona, Spain
| | - E Bisbe
- Departamento de Anestesiología, Hospital del Mar, Barcelona, Spain; Instituto de Investigación Médica Hospital del Mar: IMIM, Barcelona, Spain
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Costa AP, Pereira CL, Garção A, Rodrigues A. Transfusion Practices in Gastrointestinal Bleeding - a Tertiary Care Single-Centre Analysis. Clin Appl Thromb Hemost 2022; 28:10760296221087219. [PMID: 36503291 DOI: 10.1177/10760296221087219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Acute upper or lower Gastrointestinal bleeding (GIB) is a clinical emergency in which transfusion can be lifesaving. An individualized and restrictive transfusion strategy is recommended. This study aims to analyze and evaluate GIB transfusion practices during one year in a large tertiary hospital in Lisbon, Portugal. All patients with GIB and transfusion support during 2014 were identified and clinical data collected and statistically treated. There were 1005 GIB transfusion episodes, in a total of 494 patients. Upper GIB was more common. The median haemoglobin concentration that triggered RBC transfusion was 7,6 g/dL with a median of 2 RBC per episode. In 21,9% of episodes, RBC were used in combination with other therapies, in 70,8%, only RBC were administered and in 7,3% RBC were not used at all. In the subgroup of patients receiving FC and/or PCC there were higher median of blood products transfused: RBC (3 17 units), FFP (3 units), PC (1 unit). In a large percentage of the transfusion episodes for GIB, only RBC were used whereas only 7,3% of the GIB didn't require RBC transfusion. Patients requiring FC and/or PCC, needed more allogenic components. We observed, in accordance with the latest clinical practice guidelines and the published literature, a restrictive transfusion approach in our clinical practice.
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Affiliation(s)
- Ana Palricas Costa
- Transfusion Medicine Department, Hospital de Santa Maria, 218728Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Carla Leal Pereira
- Transfusion Medicine Department, Hospital de Santa Maria, 218728Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana Garção
- Transfusion Medicine Department, Hospital de Santa Maria, 218728Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Anabela Rodrigues
- Transfusion Medicine Department, Hospital de Santa Maria, 218728Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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Urgel Granados AC, Torres Campos A, Royo Agustín M, Rillo Lázaro A, Espallargas Donate MT, Castro Sauras Á. Influence of intra-articular tranexamic acid on cost savings and early functional outcomes in total knee arthroplasty. ACTA ACUST UNITED AC 2021. [PMID: 34112449 DOI: 10.1016/j.recote.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM Total knee arthroplasty (TKA) is a frequent intervention that can associate significant blood loss. There are several methods to avoid transfusions. One of the most relevant is tranexamic acid (TXA). Our purpose is to analyse the efficacy in terms of blood savings, transfusion needs, functional results, and cost-effectiveness of intra-articular (IA) administration in TKA. MATERIALS AND METHODS We conducted a retrospective analysis of historical cohorts (75 patients each) between January 2015 and December 2016. We included 150 patients (59,3% women) with a mean age of 73,58 years. The intervention consisted of administering 2 g of IA TXA with a contact time of 30 min. Demographic data, preoperative haematological status, surgery data, estimated total blood loss (ETBL), need for transfusion, functional results, and cost analysis were collected. The level of statistical significance was p ≤ 0,05. RESULTS The incidence of transfusion was 17,33% in the control group and 5,33% in the TXA group (p = 0,039), with a relative risk reduction of 78,3%. The TXA cohort showed a reduction in ETBL (p < 0,0005), units transfused (p = 0,019) and length of stay (p = 0,004). All early functional parameters also improved, including a 10° improvement in both flexion and extension (p < 0,0005). The use of IA TXA resulted in savings of 337,78 € per patient. CONCLUSIONS In our experience, the administration of IA TXA in TKA is a cost-effective and efficient measure in terms of blood savings and immediate postoperative functional improvement.
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Affiliation(s)
- A C Urgel Granados
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Obispo Polanco, Teruel, Spain.
| | - A Torres Campos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M Royo Agustín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Obispo Polanco, Teruel, Spain
| | - A Rillo Lázaro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Obispo Polanco, Teruel, Spain
| | | | - Á Castro Sauras
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Obispo Polanco, Teruel, Spain
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Urgel Granados AC, Torres Campos A, Royo Agustín M, Rillo Lázaro A, Espallargas Donate MT, Castro Sauras Á. Influence of intra-articular tranexamic acid on cost savings and early functional outcomes in total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33658168 DOI: 10.1016/j.recot.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND AIM Total knee arthroplasty (TKA) is a frequent intervention that can associate significant blood loss. There are several methods to avoid transfusions. One of the most relevant is tranexamic acid (TXA). Our purpose is to analyse the efficacy in terms of blood savings, transfusion needs, functional results, and cost-effectiveness of intra-articular (IA) administration in TKA. MATERIALS AND METHODS We conducted a retrospective analysis of historical cohorts (75 patients each) between January 2015 and December 2016. We included 150 patients (59.3% women) with a mean age of 73.58 years. The intervention consisted of administering 2 g of IA TXA with a contact time of 30 minutes. Demographic data, preoperative haematological status, surgery data, estimated total blood loss (ETBL), need for transfusion, functional results, and cost analysis were collected. The level of statistical significance was p ≤ 0,05. RESULTS The incidence of transfusion was 17.33% in the control group and 5.33% in the TXA group (p = 0.039), with a relative risk reduction of 78.3%. The TXA cohort showed a reduction in ETBL (p < 0.0005), units transfused (p = 0.019) and length of stay (p = 0.004). All early functional parameters also improved, including a 10° improvement in both flexion and extension (p < 0.0005). The use of IA TXA resulted in savings of 337.78 € per patient. CONCLUSIONS In our experience, the administration of IA TXA in TKA is a cost-effective and efficient measure in terms of blood savings and immediate postoperative functional improvement.
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Affiliation(s)
- A C Urgel Granados
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Obispo Polanco, Teruel, España.
| | - A Torres Campos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M Royo Agustín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Obispo Polanco, Teruel, España
| | - A Rillo Lázaro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Obispo Polanco, Teruel, España
| | | | - Á Castro Sauras
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Obispo Polanco, Teruel, España
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Abad-Motos A, Ripollés-Melchor J, Jericó C, Basora M, Aldecoa C, Cabellos-Olivares M, Navarro-Pérez R, Bisbe E, García-Erce JA. Patient Blood Management for primary hip and knee replacement. A survey among POWER.2 study researchers. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:237-244. [PMID: 32165061 DOI: 10.1016/j.redar.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Implementation of Patient Blood Management programs remain variable in Europe, and even in centres with well-established PBM programs variability exists in transfusion practices. OBJECTIVES AND METHODS We conducted a survey in order to assess current practice in perioperative Patient Blood Management in patients undergoing total hip and knee replacement among researchers involved in POWER.2 Study in Spain (an observational prospective study evaluating enhanced recovery pathways in orthopaedic surgery). RESULTS A total of 322 responses were obtained (37.8%). Half of responders check Haemoglobin levels in patients at least 4 weeks before surgery; 35% treat all anaemic patients, although 99.7% consider detection and treatment of preoperative anaemia could influence the postoperative outcomes. Lack of infrastructure (76%) and lack of time (51%) are the main stated reasons not to treat anaemic patients. Iron status is routinely checked by 19% before surgery, and 36% evaluate it solely in the anaemic patient. Hb<9.9 g/dl is the threshold to delay surgery for 61% of clinicians, and 22% would consider transfusing preoperatively clinically stable patients without active bleeding. The threshold to transfuse patients without cardiovascular disease is 8 g/dl for 43%, and 7 g/dl for 34% of the responders; 75% of clinicians consider they use "restrictive thresholds", and 90% follow the single unit transfusion policy. CONCLUSIONS The results of our survey show variability in clinical practice in Patient Blood Management in major orthopaedic surgery, despite being the surgery with the greatest tradition in these programs.
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Affiliation(s)
- A Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España.
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
| | - M Basora
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari, Barcelona, España; Anemia Working Group España (AWGE)
| | - C Aldecoa
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Valladolid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - M Cabellos-Olivares
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Guadalajara, Guadalajara, España
| | - R Navarro-Pérez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Clínico San Carlos, Madrid, España
| | - E Bisbe
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, España; Anemia Working Group España (AWGE)
| | - J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
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Lopez-Picado A, Barrachina B, Remón M, Errea M. Cost-benefit analysis of the use of tranexamic acid in total replacement hip surgery. J Clin Anesth 2019; 57:124-128. [DOI: 10.1016/j.jclinane.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/19/2019] [Accepted: 04/02/2019] [Indexed: 11/30/2022]
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Fernández Letamendi N, Fernández Letamendi T, Recasens Flores V, Montañés Gracia MA. [Reply to the letter to the editor entitled: «Effectiveness and safety of erythropoietin alpha in the patient (orthopaedic) over 65 years»]. Rev Esp Geriatr Gerontol 2019; 54:244-245. [PMID: 30755329 DOI: 10.1016/j.regg.2018.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
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9
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Colomina MJ, Olmedilla L, Villanueva MÁ, Bisbe E. Assessment of the knowledge level of the professional as regards Patient Blood Management in their organisation. Results of the MAPBM project survey. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:315-323. [PMID: 31014916 DOI: 10.1016/j.redar.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The Maturity Assessment Model in Patient Blood Management project involves the use of a matrix that evaluates the maturity of the centre as regards blood transfusion practice. This tool includes a questionnaire to be completed by physicians to determine their level of knowledge of patient blood management strategies in their centre. MATERIAL AND METHODS Forty one hospitals took part in the Maturity Assessment Model in Patient Blood Management project in 2016. The questionnaire included 10 questions, 3 about the centre, specialty, and years of experience, and 7 about patient blood management protocols in the respondent's centre. The minimum responses required per centre was calculated according to the number of beds. Responses from at least 3 different specialties were required in order to be evaluated. RESULTS A total of 1403 questionnaires were completed. The specialty with the highest completion rate was anaesthesiology (40.9%). The distribution as regards professional experience was homogeneous: <10 years, 33.4%, 10-20 years, 33%, and> 20 years 33.6%. Nearly three-quarters (74.2%) knew the patient blood management protocol used in their centre, and 60.7% knew the protocol for the treatment of pre-operative anaemia. Slightly fewer (72%) reported knowing the blood transfusion protocol (transfusion threshold) used in their centre, and 90% considered other factors besides haemoglobin in the decision to transfuse. Only 30.7% of professionals reported receiving periodic information on transfusion practices. CONCLUSIONS There is a significant lack of knowledge about preoperative anaemia and perioperative transfusion protocols used in the centres polled. Few centres provide their physicians with information on transfusion practices.
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Affiliation(s)
- M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - L Olmedilla
- Servicio de Anestesiología y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, España
| | - M Á Villanueva
- Servicio de Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Bisbe
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, España
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Osorio J, Jericó C, Miranda C, Garsot E, Luna A, Miró M, Santamaría M, Artigau E, Rodríguez-Santiago J, Castro S, Feliu J, Aldeano A, Olona C, Momblan D, Ruiz D, Galofré G, Pros I, García-Albéniz X, Lozano M, Pera M. Conducta transfusional perioperatoria en la cirugía del cáncer gástrico: análisis del registro del grupo español EURECCA de cáncer esófago-gástrico. Cir Esp 2018; 96:546-554. [DOI: 10.1016/j.ciresp.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 03/24/2018] [Indexed: 11/16/2022]
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López A, Gómez L, Petinal G, Adán N, Alvarado S, Carballo N. Is a blood sample for hemoglobins in the transfusional range reliable? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:246-251. [PMID: 29500058 DOI: 10.1016/j.redar.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the correlation and agreement in our unit and population of hemoglobin in gasometry versus hematology analyzer, to evaluate errors in transfusion or lack thereof. RESULTS strong association between Point-of-care (POC) and hematimetry, with P<.001, with a coefficient of determination r2 of 0.56, an intraclass correlation coefficient of 0.63 and a Lin's concordance correlation coefficient of 0.65. For hemoglobins less than 7g/dL, a success rate of 29.41% was obtained. CONCLUSIONS Low-moderate agreement of POC hemoglobin with standard haemothymetry. High probability of errors in the indication of transfusion based on gasometer hemoglobins, especially in low hemoglobins.
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Affiliation(s)
- A López
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España.
| | - L Gómez
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - G Petinal
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - N Adán
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - S Alvarado
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - N Carballo
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
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García E, Blanco MP, Riaño S, González-Mendibil I, Carrascosa T, Antolín MT. Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy. ACTA ACUST UNITED AC 2018. [PMID: 29525470 DOI: 10.1016/j.redar.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or "Patient Blood Management" should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery.
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Affiliation(s)
- E García
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Galdakao-Usansolo, Galdakao, España.
| | - M P Blanco
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Galdakao-Usansolo, Galdakao, España
| | - S Riaño
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Galdakao-Usansolo, Galdakao, España
| | - I González-Mendibil
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Galdakao-Usansolo, Galdakao, España
| | - T Carrascosa
- Servicio de Hematología, Hospital Galdakao-Usansolo, Galdakao, España
| | - M T Antolín
- Área de Hospitalización, Hospital Galdakao-Usansolo, Galdakao, España
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13
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Patient blood management in cardiac surgery: Results. ACTA ACUST UNITED AC 2018; 65:196-203. [PMID: 29373189 DOI: 10.1016/j.redar.2017.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/01/2017] [Accepted: 11/27/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The main objective of the study was to evaluate the effect of implementing a blood-saving programme in patients undergoing elective cardiac surgery with an analysis of the transfusion rate and complications. MATERIALS AND METHODS A single-centre, observational, retrospective, comparative study which included 604 consecutive patients older than 15 years old undergoing elective cardiac surgery. Two groups of patients were created according to whether or not they were included in a blood-saving protocol, and analysed between December 2012 and July 2013 (293 patients, prep group) and April 2015 to May 2016 (311 patients, posp group). RESULTS The overall blood product transfusion rate was reduced in the posp group (89.5 vs. 67.6%; P<0.001), as well as individually: red blood cell concentrates (83.6%; P<0.001), fresh frozen plasma (36.2 vs. 21.2%; P<0.001), platelets (40.8 vs. 32.7; P<0.001). By contrast, fibrinogen use increased from 16.4 to 49% (P<0.001). Postoperative complications were similar in both groups, except for pulmonary complications (57.8 vs. 43.1%; P<0.001). Length of hospital stay was similar in both groups except in the Critical Care Unit with longer stay for the prep group (5.81±8.00 vs. 4.18±4.38; P=0.002). Mortality did not change. CONCLUSIONS The implementation of a blood-saving programme in the cardiac surgery area has favourable consequences, such as a saving in blood product and a reduction of pulmonary complications, although without decreasing the mortality rate.
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Bielza Galindo R, Llorente Gutiérrez J, Pérez González JL, Mora Casado A, Blanco Díaz D, Escalera Alonso J, Morales Fernández A, Molano Ortiz C, García López BE, Del Amo Del Arco N, Barro Ordovas JP, Arias Muñana E, Neira Álvarez M, Sanz Rosa D, Gómez Cerezo JF. [Intravenous iron, functional recovery and delirium in patients with hip fracture. FEDEREF study. Single-centre randomised, placebo-controlled, and double-blind clinical trial. 2014-001923-53: EudraCT number]. Rev Esp Geriatr Gerontol 2018; 53:38-44. [PMID: 28292532 DOI: 10.1016/j.regg.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/17/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION There are no previous studies evaluating the effect of intravenous iron therapy on functional and cognitive status of patients with hip fracture (HF). MATERIAL AND METHODS A single-centre randomised, placebo-controlled, double-blind and parallel treatment, clinical trial has been designed to assess the efficacy of intravenous iron therapy during the peri-operative period in elderly patients suffering from a HF. Blinding will be ensured by the packaging of the drug infusion system. On days 1, 3, and 5 from admission, the intervention group will receive 200mg Venofer® (iron sucrose) diluted in 100ml saline, and the control group 100ml saline, also on days 1, 3 and 5. Patients will received conventional treatment in ortho-geriatric unit of the Hospital Infanta Sofia. Functional variables (activities of daily living and walking), cognitive (cognitive status and delirium), surgical, demographic and clinical characteristics will be collected during admission in order to assess the impact of treatment. A safety analysis of the treatment will also performed. Patients will be followed-up at 3, 6, and 12 months. RESULTS The study will attempt to provide evidence on the impact of the intravenous iron administration on functional recovery. It will be determined whether iron therapy negatively affects the incidence of post-operative delirium. Finally, report will be presented on the safety data of intravenous iron in elderly HF patients, as well as the impact on allogenic blood transfusion savings. CONCLUSIONS The inclusion of elderly HF patients admitted to an ortho-geriatric unit, in a clinical trial, will help to improve the knowledge of the treatment impact on a usual scenario, and provide useful data for use in other units.
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Affiliation(s)
- Rafael Bielza Galindo
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España.
| | - Jesús Llorente Gutiérrez
- Sección de Farmacología. Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - José Luis Pérez González
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Asunción Mora Casado
- Sección de Hematología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - David Blanco Díaz
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Javier Escalera Alonso
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Adoración Morales Fernández
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Cristina Molano Ortiz
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | | | - Nazaret Del Amo Del Arco
- Análisis Clínicos, Laboratorio de Urgencias, Hospital Infanta Sofía- BR Salud, San Sebastián de los Reyes, España
| | - Juan Pablo Barro Ordovas
- Sección de Farmacología. Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Estefanía Arias Muñana
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Marta Neira Álvarez
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - David Sanz Rosa
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, España
| | - Jorge Fco Gómez Cerezo
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
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Lopez-Picado A, Albinarrate A, Barrachina B. Determination of Perioperative Blood Loss: Accuracy or Approximation? Anesth Analg 2017; 125:280-286. [PMID: 28368940 DOI: 10.1213/ane.0000000000001992] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Various different interventions can be used to reduce surgical blood loss; however, there is no "gold standard" for accurately measuring the volume of perioperative blood loss, and this makes it difficult to assess the efficacy of these interventions. METHODS We used data from a previous multicenter double-blind randomized clinical trial in patients undergoing total hip arthroplasty in which we compared 2 regimens for administering tranexamic acid versus placebo. We assessed direct measures (external blood loss) and indirect estimates (using the formulas of Bourke, Gross, Mercuriali, and Camarasa and a new formula we have developed) using analysis of variance to compare estimated volumes of blood loss among the study groups. In addition, intraclass correlation coefficients (ICCs) and Bland-Altman diagrams were used to compare the estimated volumes of blood loss obtained with each formula. RESULTS The mean estimated external blood loss was 909 ± 324 mL, and the mean estimates of blood loss calculated using the formulas of Gross, Bourke and Smith, and Camarasa were 1308 ± 555, 1091 ± 454, and 1641 ± 945 mL, respectively, whereas we obtained a value of 1511 ± 919 mL with the new formula at day 2. In all cases, the results favored the use of tranexamic acid (P < .0001). Comparing results of the new and other formulas, we found moderate-to-low agreement (in terms of ICCs) except for that of Camarasa (ICC: 0.992). The limits of agreement with the new formula ranged from -378 to 93 in the case of the comparison with Camarasa's formula and from -2226 to 959 for external blood loss, the difference depending on the magnitude of the estimate to a large extent. CONCLUSIONS Formulas that take into account both anthropometric and laboratory parameters are useful for evaluating the efficacy of interventions aiming to decrease blood loss but do not ensure that the values obtained are sufficiently accurate for absolute measuring.
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Affiliation(s)
- A Lopez-Picado
- From the *Araba Research Unit, Araba University Hospital, Vitoria-Gasteiz, Spain; †Bioaraba Research Institute, Vitoria-Gasteiz, Spain; and ‡Department of Anaesthesia & Perioperative Care, Araba University Hospital, Vitoria-Gasteiz, Spain
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16
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Preciado Mora M, Azparren Cabezón G, Escudero Rodríguez J, Esteban Garcia C, Font Gual A, Moral García V. La anemia como factor de riesgo quirúrgico en cirugía vascular. Algoritmos de diagnóstico y tratamiento. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Colomina MJ, Basora Macaya M, Bisbe Vives E. [Implementation of blood sparing programs in Spain: results of a survey of departments of anesthesiology and resuscitation]. ACTA ACUST UNITED AC 2017; 62 Suppl 1:3-18. [PMID: 26320339 DOI: 10.1016/s0034-9356(15)30002-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The objective of this article is to determine the availability of a perioperative transfusion management program (Patient Blood Management [PBM]) in various hospitals through a survey that included a description of the preanesthesia visit, the availability and use of the various blood-sparing techniques and the factors limiting their implementation in elective surgery. The survey included 42 questions, directed at the representative departments of anesthesiology of hospitals in Spain (n=91). The survey was conducted from September to November 2012. We analyzed the 82 surveys in which all the questions were answered (90%). Preoperative consultations are routinely performed (>70%) in 87% of the hospitals. The time from the consultation to surgery varied between 1 week and 2 months for 74% of the patients scheduled for orthopedic or trauma surgery, 78% of those scheduled for oncologic surgery and 77% of those scheduled for cardiac surgery. Almost all hospitals (77, 94%) had a transfusion committee, and 90% of them had an anesthesiologist on the committee. Seventy-nine percent of the hospitals had a blood-sparing program, and the most widely used technique was the use of antifibrinolytic agents (75% of hospitals), followed by intraoperative and postoperative blood recovery in equal proportions (67%). Optimization of preoperative hemoglobin was routinely performed with intravenous iron in 39% of the hospitals and with recombinant erythropoietin in 28% of the hospitals. The absence of a well-established circuit and the lack of involvement and collaboration with the surgical team were the main limiting factors in implementing PBM. Currently, the implementation of PBM in Spain could be considered acceptable, but it could also be improved, especially in the treatment of preoperative anemia. The implementation of PBM requires multidisciplinary collaboration among all personnel responsible for perioperative care, including the health authorities.
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Affiliation(s)
- M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - E Bisbe Vives
- Servicio de Anestesiología y Reanimación, Hospital del Mar, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, España
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18
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Fernández-Ibáñez J, Morales-Ballesteros M, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes M, Cruz-Tejado J, Hernández-Zegarra P, Arias-Arias Á, García-Baltasar M. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Fernández-Ibáñez JM, Morales-Ballesteros MC, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes MD, Cruz-Tejado J, Hernández-Zegarra PA, Arias-Arias Á, García-Baltasar MM. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:88-95. [PMID: 28214194 DOI: 10.1016/j.recot.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/16/2016] [Accepted: 11/27/2016] [Indexed: 01/09/2023] Open
Abstract
AIM To describe the orthogeriatric activity in the elderly with hip fractures in the Hospital Mancha Centro, based on the recommendations of the main guidelines. MATERIAL AND METHOD Observational prospective study, comprising all patients over 65 years of age admitted to the Traumatology Unit with a hip fracture between April 2015 and December 2015. Patients were admitted under the care of the Traumatology Unit with cross-consultation carried out with the Geriatrics Department, which then carried out a pre-operative geriatric assessment and the post-operative follow-ups. RESULTS The mean pre-surgery waiting time was 48h and the overall time in hospital was 10.3±8.2 days. Patients who suffered from delirium (42.1%) did not improve as well, and were referred to nursing homes. Blood transfusions were received by 54.7% of the patients, despite 53.5% of them having received intravenous and/or oral iron after the surgery. Treatment with calcium and vitamin D was prescribed in 79% of the patients on discharge. The Rehabilitation Unit assessed 36% of the patients, with 4.8% fully, and 16.7% partially recovering their prior functional status. Upon discharge, 55% of the patients returned to their homes, and 22% were referred to short-term assisted living facilities. DISCUSSION This article describes how the main clinical problems are handled in the elderly with hip fractures in our hospital, based on recommendations of the main guidelines and publications. CONCLUSIONS Our hospital follows the recommended guidelines. Aspects for improvement include the management of anaemia during admission and rehabilitation.
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Affiliation(s)
- J M Fernández-Ibáñez
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | - M C Morales-Ballesteros
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - E Crespo-Romero
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - S Gómez-Gómez
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M D Fraga-Fuentes
- Servicio de Farmacia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - J Cruz-Tejado
- Servicio de Anestesia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - P A Hernández-Zegarra
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Á Arias-Arias
- Unidad de Investigación, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M M García-Baltasar
- Servicio de Trabajo Social, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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20
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Castro-Menéndez M, Pena-Paz S, Rocha-García F, Rodríguez-Casas N, Huici-Izco R, Montero-Viéites A. Efficacy of 2 grammes of intravenous transexamic acid in the reduction of post-surgical bleeding after total hip and knee replacement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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21
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Quecedo Gutiérrez L, Ruiz Abascal R, Calvo Vecino JM, Peral García AI, Matute González E, Muñoz Alameda LE, Guasch Arévalo E, Gilsanz Rodríguez F. "Do not do" recommendations of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy. "Commitment to Quality by Scientific Societies" Project. ACTA ACUST UNITED AC 2016; 63:519-527. [PMID: 27418334 DOI: 10.1016/j.redar.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/07/2016] [Indexed: 10/21/2022]
Abstract
In April 2013 the Ministry of Health (MSSSI) adopted the project called "Commitment to Quality by Scientific Societies in Spain", in response to social and professional demands for sustainability of the health system. The initiative is part of the activities of the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System, and is coordinated jointly by the Quality and Cohesion Department, the Aragon Institute of Health Sciences (IACS), and the Spanish Society of Internal Medicine (SEMI). All the scientific societies in Spain have been included in this project, and its main objective is to reduce the unnecessary use of health interventions in order to agree "do not do" recommendations, based on scientific evidence. The primary objective was to identify interventions that have not proven effective, have limited or doubtful effectiveness, are not cost-effective, or do not have priority. Secondary objectives were: reducing variability in clinical practice, to spread information between doctors and patients to guide decision-making, the appropriate use of health resources and, the promotion of clinical safety and reducing iatrogenesis. The selection process of the 5 "do not do" recommendations was made by Delphi methodology. A total of 25 panellists (all anaesthesiologists) chose between 15 proposals based on: evidence that supports quality, relevance, or clinical impact, and the people they affect. The 5 recommendations proposed were: Do not maintain deep levels of sedation in critically ill patients without a specific indication; Do not perform preoperative chest radiography in patients under 40 years-old with ASA physical status I or II; Do not systematically perform preoperative tests in cataract surgery unless otherwise indicated based on clinical history and physical examination; Do not perform elective surgery in patients with anaemia at risk of bleeding until a diagnostic workup is performed and treatment is given; and not perform laboratory tests (blood count, biochemistry and coagulation) prior to surgery in healthy or low risk patients (ASA I and II) with minimal estimated blood loss.
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Affiliation(s)
- L Quecedo Gutiérrez
- Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital La Princesa, Madrid, España
| | - R Ruiz Abascal
- Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital Sanitas La Moraleja, Madrid, España
| | - J M Calvo Vecino
- Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital Universitario Infanta Leonor, Madrid, España.
| | - A I Peral García
- Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital La Princesa, Madrid, España
| | - E Matute González
- Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital Sanitas La Moraleja, Madrid, España
| | - L E Muñoz Alameda
- Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Fundación Jiménez Díaz, IDC Salud, Madrid, España
| | - E Guasch Arévalo
- Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz Rodríguez
- Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital Universitario La Paz, Madrid, España
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22
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Castro-Menéndez M, Pena-Paz S, Rocha-García F, Rodríguez-Casas N, Huici-Izco R, Montero-Viéites A. Efficacy of 2 grammes of intravenous transexamic acid in the reduction of post-surgical bleeding after total hip and knee replacement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:315-24. [PMID: 27342383 DOI: 10.1016/j.recot.2016.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/23/2016] [Accepted: 05/05/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is currently sufficient clinical evidence to recommend tranexamic acid (TXA) for reducing post-operative blood loss in total knee and hip arthroplasty, however, its optimal dose and administration regimes are unknown. OBJECTIVE Analyse effectiveness and safety of TXA in total hip and knee arthroplasty using 2 grammes (g) intravenously in two different regimes. MATERIAL AND METHODS A prospective randomised intervention study was conducted on a total of 240 patients. The patients were divided into 3 groups: 1) control; 2) 1g of TXA intraoperative, followed by another postoperative; and 3): 2g preoperative. Each group consisted of 40 patients undergoing total knee arthroplasty, and 40 total hip arthroplasty. Postoperative blood loss, transfusion rate, and thromboembolic complications were studied. RESULTS There were significant differences (p<.005) when comparing mean total blood loss and transfusion between group 1 and 2, and between group 1 and 3, but not between the two TXA groups (2 and 3). The authors only recorded one complication in group 1 (deep vein thrombosis). DISCUSION This study was not performed to investigate the already well established effectiveness of TXA, but to confirm if 2 empirical intravenous g is safe, and what is most beneficial regimen. In conclusion, according to the literature, both proven patterns of 2g intravenous of TXA are effective in reducing blood loss and transfusion requirements, without increasing the complication rate.
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Affiliation(s)
- M Castro-Menéndez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, España.
| | - S Pena-Paz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Lucus Augusta, Lugo, España
| | - F Rocha-García
- Servicio de Anestesia y Reanimación, Hospital de Monforte de Lemos, Lugo, España
| | - N Rodríguez-Casas
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, España
| | - R Huici-Izco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, España
| | - A Montero-Viéites
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, España
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23
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Massive obstetric hemorrhage: Current approach to management. Med Intensiva 2016; 40:298-310. [PMID: 27184441 DOI: 10.1016/j.medin.2016.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/11/2016] [Accepted: 02/18/2016] [Indexed: 01/25/2023]
Abstract
Massive obstetric hemorrhage is a major cause of maternal mortality and morbidity worldwide. It is defined (among others) as the loss of>2,500ml of blood, and is associated to a need for admission to critical care and/or hysterectomy. The relative hemodilution and high cardiac output found in normal pregnancy allows substantial bleeding before a drop in hemoglobin and/or hematocrit can be identified. Some comorbidities associated with pregnancy can contribute to the occurrence of catastrophic bleeding with consumption coagulopathy, which makes the situation even worse. Optimization, preparation, rational use of resources and protocolization of actions are often useful to improve outcomes in patients with postpartum hemorrhage. Using massive obstetric hemorrhage protocols is useful for facilitating rapid transfusion if needed, and can also be cost-effective. If hypofibrinogenemia during the bleeding episode is identified, early fibrinogen administration can be very useful. Other coagulation factors in addition to fibrinogen may be necessary during postpartum hemorrhage replacement measures in order to effectively correct coagulopathy. A hysterectomy is recommended if the medical and surgical measures prove ineffective.
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24
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Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Sanz-Reig J, Parra Ruiz B, Ferrández Martínez J, Martínez López J. Dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:106-12. [DOI: 10.1016/j.recot.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/20/2015] [Accepted: 11/09/2015] [Indexed: 01/30/2023] Open
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26
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Llau JV, Acosta FJ, Escolar G, Fernández-Mondéjar E, Guasch E, Marco P, Paniagua P, Páramo JA, Quintana M, Torrabadella P. [Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document)]. ACTA ACUST UNITED AC 2015; 63:e1-e22. [PMID: 26688462 DOI: 10.1016/j.redar.2015.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/17/2015] [Indexed: 12/23/2022]
Abstract
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).
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Affiliation(s)
- J V Llau
- Anestesia y Reanimación, Hospital Clínico Universitario de Valencia, Valencia, España
| | - F J Acosta
- Anestesia y Reanimación, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - G Escolar
- Hemoterapia y Hematología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - E Fernández-Mondéjar
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen de las Nieves; Instituto de Investigación Biosanitaria ibs.Granada, Granada, España.
| | - E Guasch
- Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - P Marco
- Hemoterapia y Hematología, Hospital General de Alicante, Alicante, España
| | - P Paniagua
- Anestesia y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J A Páramo
- Hematología y Hemoterapia, Clínica Universidad de Navarra, Pamplona, España
| | - M Quintana
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
| | - P Torrabadella
- Unidad de Cuidados Intensivos, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
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Jericó C, Bretón I, García Ruiz de Gordejuela A, de Oliveira AC, Rubio MÁ, Tinahones FJ, Vidal J, Vilarrasa N. [Diagnosis and treatment of iron deficiency, with or without anemia, before and after bariatric surgery]. ACTA ACUST UNITED AC 2015; 63:32-42. [PMID: 26611153 DOI: 10.1016/j.endonu.2015.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023]
Abstract
Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery.
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Affiliation(s)
- Carlos Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Barcelona, España. Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org).
| | - Irene Bretón
- Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición, Hospital Gregorio Marañón, Madrid, España
| | - Amador García Ruiz de Gordejuela
- Unidad de Cirugía Bariátrica y Metabólica. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Francisco J Tinahones
- Servicio de Endocrinología, Hospital Virgen de la Victoria, Málaga, España; CIBEROBN Instituto de Salud Carlos III, Madrid, España
| | - Josep Vidal
- Unidad de obesidad, Hospital Clínic Universitari, Barcelona, España. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, España
| | - Nuria Vilarrasa
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Bellvitge-IDIBELL, Barcelona, España. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
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Llau JV, Acosta FJ, Escolar G, Fernández-Mondéjar E, Guasch E, Marco P, Paniagua P, Páramo JA, Quintana M, Torrabadella P. Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document). Med Intensiva 2015; 39:483-504. [PMID: 26233588 DOI: 10.1016/j.medin.2015.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/14/2015] [Accepted: 05/17/2015] [Indexed: 12/30/2022]
Abstract
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).
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Affiliation(s)
- J V Llau
- Anestesia y Reanimación, Hospital Clínico Universitario de Valencia, Valencia, España
| | - F J Acosta
- Anestesia y Reanimación, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - G Escolar
- Hemoterapia y Hematología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - E Fernández-Mondéjar
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen de las Nieves; Instituto de Investigación Biosanitaria ibs.Granada, Granada, España.
| | - E Guasch
- Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - P Marco
- Hemoterapia y Hematología, Hospital General de Alicante, Alicante, España
| | - P Paniagua
- Anestesia y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J A Páramo
- Hematología y Hemoterapia, Clínica Universidad de Navarra, Pamplona, España
| | - M Quintana
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
| | - P Torrabadella
- Unidad de Cuidados Intensivos, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
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29
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Albinarrate A, López-Picado A, Oiartzabal I, López-Ariznabarreta C, Molano J, Barrachina B. Assessment of the introduction of a blood management program in orthopaedic surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:443-449. [PMID: 25315985 DOI: 10.1016/j.redar.2014.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the impact of implementing a Patient Blood management program (PBM) on transfusion rates, hospital stay, and complications for total hip arthroplasty (THA) and total knee arthroplasty (TKA). MATERIAL AND METHODS A retrospective, observational study was conducted in Araba University Hospital from 2006 to 2011. All THA and TKA were included. The percentage of patients transfused with allogeneic blood was the primary endpoint. The mean of transfused blood bags, overall transfusion, complications (both overall and specific), patient age and sex, pre-operative and discharge hemoglobin, and hospital stay were recorded. RESULTS A total of 825 THA and 875 TKA were included. Both THA (47.6% in 2006 and 30.6% in 2011; P=.013) and TKA (33.6% in 2006 and 16.2% in 2011; P<.001) showed a significant decrease of allogeneic transfusion. The overall transfusion rate was also reduced in THA (65.7% in 2006 and 39.5% in 2011; P<.001) and TKA (38.3% in 2006 and 17.2% in 2011; P<.001). Hospital stay was reduced in both types of surgeries (P<.038 in THA and P<.0001 in TKA). In 2006 it was 9.2±2.9 days for THA and 11.1±4.7 days for TKA, whereas in 2011 it was 8.7±4.2 and 9.5±3.4 days for THA and TKA, respectively. CONCLUSIONS Our patient blood management has decreased the percentage of patients that need both allogeneic and autologous transfusion in a statistically significant way. Although the mean hospital stay decreased, the impact of the PBM cannot be established.
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Affiliation(s)
- A Albinarrate
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España.
| | - A López-Picado
- Unidad de Investigación de Araba, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - I Oiartzabal
- Servicio de Hematología, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - C López-Ariznabarreta
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - J Molano
- Servicio de Cirugía Ortopédica, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - B Barrachina
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
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30
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Abstract
Iron deficiency is more common in women due to uterine bleeding, which affects them throughout their fertile life. Additionally, iron needs increase physiologically during pregnancy and breastfeeding. Pregnant women therefore constitute one of the risk groups for iron deficiency. During the postpartum period, iron deficiency is the most common cause of anemia. Longer hospital stays and greater susceptibility to infections are potential consequences of postpartum anemia.
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Affiliation(s)
- E Gredilla Díaz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
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31
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Abstract
Repairing hip fractures is one of the most common surgical procedures and has greater morbidity and mortality. This procedure is also a process that involves a greater need for blood products. Numerous factors influence morbidity, mortality and the use of blood products: patient age, concomitant diseases and drug treatments that change hemostasis and hemorrhaging (preoperative, intraoperative and postoperative), which are usually significant. On top of all this is the presence in a high percentage of cases of preoperative anemia, which can have one or more causes. It is therefore essential to establish an appropriate management of perioperative anemia and optimize the transfusion policy. The aim of this review is to briefly analyze the epidemiology of hip fractures as well as establish a basis for treating perioperative anemia and transfusion policies, proposing guidelines and recommendations for clinical management based on the most current studies.
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32
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Díaz-Cambronero O, Matoses-Jaén S, García-Claudio N, García-Gregorio N, Molins-Espinosa J. [Preoperative management of anemia in oncologic surgery]. ACTA ACUST UNITED AC 2015; 62 Suppl 1:45-51. [PMID: 26320344 DOI: 10.1016/s0034-9356(15)30007-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Preoperative anemia in patients with cancer is highly prevalent, is associated with increased perioperative morbidity and is a risk factor for transfusion. There is evidence that patients who undergo transfusions have higher morbidity, increased cancer recurrence and poorer survival. The pathophysiology of anemia is multifactorial, with an inflammatory component to which chronic blood loss and nutritional deficiencies can be associated. Therefore, preoperative anemia in patients with cancer should be treated appropriately, given that there is sufficient time in the preoperative period. Of the currently available options, parenteral iron is an effective alternative, especially for those types of cancer that have an associated hemorrhagic component.
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Affiliation(s)
- O Díaz-Cambronero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | - S Matoses-Jaén
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - N García-Claudio
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - N García-Gregorio
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - J Molins-Espinosa
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
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33
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Colomina MJ, Basora Macaya M. [Optimization of preoperative hemoglobin levels in patients without anemia and/or patients who undergo surgery with high blood loss]. ACTA ACUST UNITED AC 2015; 62 Suppl 1:35-40. [PMID: 26320342 DOI: 10.1016/s0034-9356(15)30005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To minimize allogeneic blood transfusions (ABTs) during complex surgery and surgery with considerable blood loss risk, various blood-sparing techniques are needed (multimodal approach). All surgical patients should be assessed with sufficient time to optimize hemoglobin levels and iron reserves so that the established perioperative transfusion strategy is appropriate. Even if the patient does not have anemia, improving hemoglobin levels to reduce the risk of ABT is justified in some cases, especially those in which the patient refuses a transfusion. Treatment with iron and/or erythropoietic agents might also be justified for cases that need a significant autologous blood reserve to minimize ABT during surgery with considerable blood loss.
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Affiliation(s)
- M J Colomina
- Servicio de Anestesiología y Reanimación, Área de Traumatología, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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34
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Perez-Ferrer A, Gredilla-Díaz E, de Vicente-Sánchez J, Navarro-Suay R, Gilsanz-Rodríguez F. Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery. ACTA ACUST UNITED AC 2015; 63:78-83. [PMID: 26162899 DOI: 10.1016/j.redar.2015.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. MATERIAL AND METHODS A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. RESULTS The processed shed volume was very low (939±569ml) with high variability (coefficient of variation=0.6), unlike the recovered volume 129±50ml (coefficient of variation=0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11±5.3g dl(-1); haematocrit: 32.1±15.4% (lower than expected); white cells 5.34±4.22×103 ul(-)1; platelets 37.88±23.5×103 ul(-1) (mean±SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (-) was isolated. CONCLUSIONS Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery.
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Affiliation(s)
- A Perez-Ferrer
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Gredilla-Díaz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - J de Vicente-Sánchez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - R Navarro-Suay
- Servicio de Anestesiología y Reanimación, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - F Gilsanz-Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
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35
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Pérez-Ferrer A, Gredilla-Díaz E, de Vicente-Sánchez J, Sánchez Pérez-Grueso F, Gilsanz-Rodríguez F. Implementation of a patient blood management program in pediatric scoliosis surgery. ACTA ACUST UNITED AC 2015; 63:69-77. [PMID: 26049212 DOI: 10.1016/j.redar.2015.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/07/2015] [Accepted: 04/19/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. MATERIAL AND METHOD Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution. RESULTS The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units. CONCLUSIONS The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases.
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Affiliation(s)
- A Pérez-Ferrer
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Gredilla-Díaz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - J de Vicente-Sánchez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - F Sánchez Pérez-Grueso
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz-Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
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36
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Bisbe Vives E, Moltó L. [Therapeutic approach to postoperative anemia]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62 Suppl 1:41-44. [PMID: 26320343 DOI: 10.1016/s0034-9356(15)30006-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Postoperative anemia is a common finding in patients who undergo major surgery, and it can affect early rehabilitation and the return to daily activities. Allogeneic blood transfusion is still the most widely used method for restoring hemoglobin levels rapidly and effectively. However, the potential risks of transfusions have led to the review of this practice and to a search for alternative measures for treating postoperative anemia. The early administration of intravenous iron appears to improve the evolution of postoperative hemoglobin levels and reduce allogeneic transfusions, especially in patients with significant iron deficiency or anemia. What is not clear is whether this treatment heavily influences rehabilitation and quality of life. There is a lack of well-designed, sufficiently large, randomized prospective studies to determine whether postoperative or perioperative intravenous iron treatment, with or without recombinant erythropoietin, has a role in the recovery from postoperative anemia, in reducing transfusions and morbidity rates and in improving exercise capacity and quality of life.
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Affiliation(s)
- E Bisbe Vives
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Barcelona, España.
| | - L Moltó
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Barcelona, España
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37
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Muñoz Gómez M, Leal Noval SR. [Perioperative anemia correction in Patient Blood Management programs: Lights and shadows]. ACTA ACUST UNITED AC 2015; 62:421-4. [PMID: 25823957 DOI: 10.1016/j.redar.2015.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 01/28/2023]
Affiliation(s)
- M Muñoz Gómez
- Vicecoordinador del Documento Sevilla 2013; Medicina Transfusional Perioperatoria, Facultad de Medicina, Málaga, España.
| | - S R Leal Noval
- Coordinador del Documento Sevilla 2013; División de Cuidados Críticos, Hospital Universitario Virgen del Rocío e Instituto de Biomedicina IBIS, Sevilla, España
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38
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García Erce JA, Peral García AI, Bueno Cabrera JL. «Patient Blood Management» in obstetric hemorrhage. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:231-232. [PMID: 25443865 DOI: 10.1016/j.redar.2014.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 06/04/2023]
Affiliation(s)
- J A García Erce
- Servicio de Hematología y Hemoterapia, Hospital San Jorge, Huesca, España; AWGE-GIEMSA; IdiPAZ 49.
| | - A I Peral García
- Unidad de Ahorro de Sangre, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J L Bueno Cabrera
- Servicio Transfusión, Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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39
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Pareja Sierra T, Rodriguez Solis J. Tratamiento médico perioperatorio del anciano ingresado por fractura de cadera. Med Clin (Barc) 2014; 143:455-60. [DOI: 10.1016/j.medcli.2014.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 12/29/2022]
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40
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[Orthogeriatric activity in public hospitals of Castilla y León: description and review of the literature]. Rev Esp Geriatr Gerontol 2014; 49:137-44. [PMID: 24565685 DOI: 10.1016/j.regg.2014.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/07/2014] [Accepted: 01/10/2014] [Indexed: 01/04/2023]
Abstract
The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides.
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41
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Aguilera-Roig X, Jordán-Sales M, Natera-Cisneros L, Monllau-García J, Martínez-Zapata M. Tranexamic acid in orthopedic surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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42
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Aguilera-Roig X, Jordán-Sales M, Natera-Cisneros L, Monllau-García JC, Martínez-Zapata MJ. [Tranexamic acid in orthopedic surgery]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 58:52-6. [PMID: 24126146 DOI: 10.1016/j.recot.2013.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 11/24/2022] Open
Abstract
Perioperative bleeding may require blood transfusions, which are sometimes not without complications and risks, with the subsequent increase in health care costs. Among other prevention methods, treatment with tranexamic acid (ATX) has shown to be effective in reducing surgical blood loss, especially in the immediate postoperative period. In this regard, studies evaluating ATX in orthopedic surgery show that it is effective and safe when administered intravenously or intra-articularly. The usual evaluated intravenous doses range between 10mg/Kg and 20mg/kg or a fixed dose of 1g to 2g; while intra-articularly, it varies between 250 mg and 3g. ATX, as an anti-fibrinolytic has a potential thrombotic effect, thus it is contraindicated in those patients at risk or with a history of thrombosis. Its topical administration may be safer, but studies are needed to confirm this.
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Affiliation(s)
- X Aguilera-Roig
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
| | - M Jordán-Sales
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - L Natera-Cisneros
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - J C Monllau-García
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - M J Martínez-Zapata
- Instituto de Investigación Biomédica Sant Pau, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, España
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43
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Fàbregas Julià N. [The last 10 years of the Revista Española de Anestesiología y Reanimación: Its incorporation into «continuing education», its integration to «digital format» and its aim to be included in an international citation index]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:301-303. [PMID: 23726503 DOI: 10.1016/j.redar.2013.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 06/02/2023]
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44
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Errando CL, Fernández-Mondéjar E, Piñeiro Corrales G. [The "2013 Seville Document" on allogeneic blood transfusion alternatives: a consensus document and an example of multidisciplinary medical cooperation]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:243-244. [PMID: 23623776 DOI: 10.1016/j.redar.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/21/2013] [Indexed: 06/02/2023]
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