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Effect of acute normovolemic hemodilution on anesthetic effect, plasma concentration, and recovery quality in elderly patients undergoing spinal surgery
Liu, T., Bai, Y., Yin, L., Wang, J. H., Yao, N., You, L. W., Guo, J. R.
BMC geriatrics. 2023;23(1):689
Abstract
OBJECTIVE To explore the effect of acute normovolemic hemodilution (ANH) on the anesthetic effect, plasma concentration, and postoperative recovery quality in elderly patients undergoing spinal surgery. METHODS A total of 60 cases of elderly patients aged 65 to 75 years who underwent elective multilevel spinal surgery were assigned randomly into the ANH group (n = 30) and control group (n = 30). Hemodynamic and blood gas analysis indexes were observed and recorded before ANH (T(1)), after ANH (T(2)), immediately after postoperative autologous blood transfusion (T(3)), 10 min (T(4)), 20 min (T(5)), 30 min (T(6)), 40 min (T(7)), and 50 min (T(8)) after the transfusion, and at the end of the transfusion (i.e., 60 min; T(9)). At T(3 ~ 9), bispectral index (BIS) and train-of-four (TOF) stimulation were recorded and the plasma propofol/cisatracurium concentration was determined. The extubation time and recovery quality were recorded. RESULTS The ANH group presented a lower MAP value and a higher SVV value at T(2), and shorter extubation and orientation recovery time (P < 0.05) compared with the control group. BIS values at T(8) and T(9) were lower in the ANH group than those in the control group (P < 0.05). TOF values at T(7 ~ 9) were lower in the ANH group than those in the control group (P < 0.05). There were no statistically significant differences in the postoperative plasma concentrations of propofol and cisatracurium between the groups (P > 0.05). CONCLUSION During orthopedic surgery, the plasma concentration of elderly patients is increased after autologous blood transfusion of ANH, and the depth of anesthesia and muscle relaxant effect are strengthened, thus leading to delayed recovery of respiratory function and extubation.
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A comparative study on the efficacy of robot of stereotactic assistant and frame-assisted stereotactic drilling, drainage for intracerebral hematoma in patients with hypertensive intracerebral hemorrhage
Liang L, Li X, Dong H, Gong X, Wang G
Pakistan journal of medical sciences. 2022;38(7):1796-1801
Abstract
OBJECTIVES To compare the clinical efficacy of robot of stereotactic assistant (ROSA) and frame-assisted stereotactic drilling and drainage for intracerebral hematoma in hypertensive intracerebral hemorrhage (HICH). METHODS A total of 142 patients with HICH treated in Baoding First Central Hospital from January 2018 to January 2020 were selected and divided into two groups using a random number table. The ROSA group was treated with a robot of stereotactic assistant, while the frame group underwent frame-assisted stereotactic drilling and drainage for intracerebral hematoma. Surgical duration, postoperative extubation time and complications were compared between the two groups. Venous blood (5 mL) was collected before and three days after surgery. The levels of inflammatory factors [tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6)], as well as neurological function indexes [neuron-specific enolase (NSE), nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF)] were detected by enzyme-linked immunosorbent assay. RESULTS The surgical duration, postoperative extubation time, and incidences of infection and postoperative rehemorrhage in the ROSA group were lower than those in the frame group (P < 0.05). In the ROSA group, postoperative TNF-α, hs-CRP, IL-6 and NSE levels were significantly lower while NGF and BDNF levels were higher than those in the frame group (all P < 0.05). CONCLUSION Compared with frame-assisted stereotactic drilling and drainage for intracerebral hematoma, ROSA in HICH treatment shortens the surgical duration and postoperative extubation time, reduces the risks of infection and rehemorrhage and decreases inflammatory level, which is helpful for the recovery of neurological function.
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Postoperative outcomes of pedicle screw instrumentation for adolescent idiopathic scoliosis with and without a subfascial wound drain: a multicentre randomized controlled trial
Helenius, L., Gerdhem, P., Ahonen, M., Syvänen, J., Jalkanen, J., Charalampidis, A., Nietosvaara, Y., Helenius, I.
The Bone & Joint Journal. 2022;104-b(9):1067-1072
Abstract
AIMS: The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. METHODS Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications. RESULTS All 90 patients were included in the primary outcome analysis (no drain = 43; drain = 47). The mean total postoperative blood loss (intraoperative and drain output) was significantly higher in the group with a subfascial drain than in the no-drain group (1,008 ml (SD 520) vs 631 ml (SD 518); p < 0.001). The drop in haemoglobin level did not differ between the study groups over the postoperative timepoints (p = 0.290). The 48-hour opioid consumption was significantly higher in the no-drain group (2.0 mg/kg (SD 0.9) vs 1.4 (SD 0.6); p = 0.005). Two patients in the no-drain and one patient in the drain group developed a surgical site infection. CONCLUSION Leaving the subfascial drain out after pedicle screw instrumentation for AIS is not associated with higher postoperative haemoglobin levels. Patients treated without a subfascial drain needed 30% more opioids during the first 48 hours than those who had a drain.Cite this article: Bone Joint J 2022;104-B(9):1067-1072.
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Comparison of the curative effect and prognosis of stereotactic drainage and conservative treatment for moderate and small basal ganglia haemorrhage
Huang X, Jiang L, Chen S, Li G, Pan W, Peng L, Yan Z
BMC neurology. 2021;21(1):268
Abstract
BACKGROUND Minimally invasive surgery has achieved good results in the treatment of cerebral haemorrhage.However, no large-scale clinical study has demonstrated that surgical treatment of cerebral haemorrhages less than 30 ml can improve the curative effect. Our study explored the efficacy and complication of stereotactic drainage based on the amount of cerebral hemorrhage (15-30 ml) in hypertensive basal ganglia. METHOD Sixty patients with hypertensive basal ganglia haemorrhages were divided into a control group and an experimental group with 30 patients in each group. Patients in the control group were treated conservatively. In contrast, those in the experimental group received stereotactic drainage, and urokinase was injected into the haematoma cavity after the operation. The haematoma volume at admission and 1, 3, 7 and 30 days after treatment and National Institute of Health stroke scale(NIHSS) score data were recorded. Complications after treatment in the two groups of data were compared and analysed. RESULT No significant differences in age, sex, time of treatment after onset, admission blood pressure, admission haematoma volume or admission NIHSS score were noted between these two groups (P > 0.05). After treatment, significant differences in haematoma volume were noted between the two groups on the 1st, 3rd, 7th and 30th days after treatment (P < 0.05). The amount of hematoma of patients in the experimental group was significantly reduced compared with that in the control group, and the NIHSS scores were significantly different on the 3rd, 7th and 30th days after treatment. The neurological deficit scores of patients in the experimental group were significantly reduced compared with those in the control group, and the incidence of pulmonary infection and venous thrombosis in the lower limbs of patients in the experimental group were significantly reduced (P < 0.05). ROC curve analysis showed that stereotactic drainage affected the early neurological function of patients with small and medium basal ganglia haemorrhages. CONCLUSION For patients with small and medium basal ganglia haemorrhages, stereotactic drainage can be used due to the faster drainage speed of haematomas after operation, which is beneficial to the recovery of neurological function and reduce complications.
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Hemoglobin Concentration May Affect the Effect of Atorvastin on Chronic Subdural Hematoma After Burr-Hole Drainage at High Altitude
Wei L, Lin C, Zhong M, Zhang J, Zhu G
Front Neurosci. 2020;14:503
Abstract
Objective: Chronic subdural hematoma (CSDH) is a common disease. Atorvastatin calcium can increase CSDH absorption. However, whether atorvastatin can increase hematoma absorption and reduce recurrence at high altitudes is not clear. Methods: After burr-hole drainage, CSDH patients were divided into an atorvastatin group and a control group. Follow-up computed tomography (CT) was performed on day 1, months 1, 2, and 3 after surgery. Then, the recurrence rate, poor therapeutic effect, time to recurrence, poor surgical result, recurrence with operation, CSDH volume, and Markwalder grading scale score (MGSS) were calculated, and related risk factors were analyzed. Results: The non-recurrent and recurrent patients in the control group differed significantly in terms of the hemoglobin concentration (HB) [176.24 +/- 16.43 vs. 194.25 +/- 12.34 (g/L), p < 0.01], CT value [41.92 +/- 10.76 vs. 34.12 +/- 8.78 (Hu), p < 0.01], and low-density time [3.88 +/- 1.04 vs. 5.50 +/- 0.87 (d), p < 0.01]. The non-recurrent and recurrent patients in the atorvastatin group differed significantly in terms of the HB [172.66 +/- 16.41 vs. 190.45 +/- 10.23 (g/L), p < 0.01], CT value [38.91 +/- 7.16 vs. 29.50 +/- 8.61 (Hu), p < 0.01], and mixed [2 vs. 4 (n), p < 0.05] and low-density time [4.09 +/- 0.75 vs. 5.45 +/- 1.12 (d), p < 0.01]. The logistic regression analysis showed that HB [odds ratio, 1.14; 95% confidence interval (CI), 1.04-1.25 in the control group, odds ratio, 1.13; 95% CI, 1.03-1.23 in the atorvastatin group] and low-density time (odds ratio, 3.53; 95% CI, 1.42-8.74 in the control group, odds ratio, 2.53; 95% CI, 1.10-5.80 in the atorvastatin group) were possible risk factors for the two groups. The receiver operating characteristic curves showed that the area under the receiver operating characteristic curve values for the HB, CT value (Hu), and low-density time were 0.812, 0.702, and 0.755 for all subjects; 0.812, 0.719, and 0.790 for the control group; and 0.807, 0.682, and 0.756 for the atorvastatin group, respectively. The postoperative follow-up results showed that there was no significant difference in the recurrence rate, poor therapeutic effect, time to recurrence, poor surgical result, recurrence with operation, CSDH volume, or MGSS between the two groups. Conclusion: The effect of atorvastatin was not significant after the operation. The risk factors for CSDH recurrence were the HB and low-density time. The HB was the most specific and sensitive predictor of CSDH recurrence.
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Does prophylactic use of topical gelatin-thrombin matrix sealant affect postoperative drainage volume and hematoma formation following microendoscopic spine surgery?: a randomized controlled trial
Takami M, Yoshida M, Minamide A, Hashizume H, Yukawa Y, Nakagawa Y, Iwasaki H, Tsutsui S, Nagata K, Taiji R, et al
The spine journal : official journal of the North American Spine Society. 2020
Abstract
BACKGROUND CONTEXT Microendoscopic spinal surgery has demonstrated efficacy and is increasingly utilized as a minimally invasive approach to neural decompression, but there is a theoretical concern that bleeding and postoperative epidural hematoma (PEH) may occur with increased frequency in a contained small surgical field. Hemostatic agents, such as topical gelatin-thrombin matrix sealant (TGTMS), are routinely used in spine surgery procedures, yet there has been no data on whether PEH is suppressed by these agents when administered in microendoscopic spine surgery. PURPOSE The purpose of this study was to investigate the effect of TGTMS on bleeding and PEH formation in lumbar micoroendoscopic surgery. STUDY DESIGN This is a randomized controlled trial (RCT) with additional prospective observational cohort. PATIENT SAMPLE Patients were registered from July 2017 to September 2018 and a hundred and three patients undergoing microendoscopic laminectomy for lumbar spinal stenosis at a single institution were enrolled in this study. OUTCOME MEASURES The primary outcome was the drainage volume within 48 hours after surgery. Secondary outcomes were the numerical rating scale (NRS) of leg pain on the second (NRS2) and seventh day (NRS7) after surgery and the hematoma area ratio (HAR) in horizontal images on magnetic resonance image (MRI). METHODS In the RCT, 41 cases that received TGTMS (F group) were compared with 41 control group cases (C group) that did not receive TGTMS at the end of the procedure. Drainage volume, NRS2, NRS7, and HAR on MRI were evaluated. Nineteen cases were excluded from the RCT (I group) due to difficulty of hemostasis during surgery and the intentional use of TGTMS for hemostasis. I group was compared with C group in the drainage volume and NRS of leg pain as a prospective observational study. RESULTS The RCT demonstrated no statistically significant difference in drainage volume between those receiving TGTMS (117.0±71.7; mean±standard deviation) and controls (125.0±127.0) (p=0.345). The NRS2 and NRS7 was 3.5±2.6 and 2.8±2.5 in the F group, respectively, and 3.1±2.6 and 2.1±2.3 in the C group, respectively. The HAR on MRI was 0.19±0.19 in the F group and 0.17±0.13 in the C group. There was no significant difference in postoperative leg pain and HAR (p=0.644 for NRS2, p=0.129 for NRS7, and p=0.705 for HAR). In the secondary observational cohort, the drainage volume in the I group was 118.3±151.4, and NRS2 and NRS7 was 3.5±2.0 and 2.6±2.6, respectively. There were no statistically significant differences in drainage volume (p=0.386) or postoperative NRS of leg pain between these two groups (p=0.981 and 0.477 for NRS2 and NRS7, respectively). CONCLUSIONS The prophylactic use of TGTMS in patients undergoing microendoscopic laminotomy for lumbar spinal stenosis did not demonstrate any difference in postoperative bleeding or PEH. Nonetheless, for patients that had active bleeding that required the use of TGTMS, there was no evidence of difference in postoperative clinical outcomes relative to controls.
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Efficacy of intraoperative cell salvage in spine surgery: a meta-analysis
Cheriyan J, Cheriyan T, Dua A, Goldstein JA, Errico TJ, Kumar V
J Neurosurg Spine. 2020;:1-9
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Editor's Choice
Abstract
OBJECTIVE Intraoperative cell salvage systems, or cell savers, are widely used for the management of blood loss in patients undergoing spine surgery. However, recent studies report conflicting evidence of their efficacy. The purpose of the meta-analysis was to investigate the efficacy of cell savers in reducing blood transfusion requirements in patients undergoing spine surgery. METHODS Both retrospective and prospective studies that investigated the efficacy of cell savers in reducing transfusion requirements in spine surgery patients when compared with control patients were identified from MEDLINE, Embase, Cochrane Collaboration Library, Google Scholar, and Scopus databases. Outcome data extracted included number of patients receiving allogenic transfusions (transfusion rate); units of allogenic transfusions; postoperative hemoglobin; costs; operative time; and complications. RevMan 5 software was used to perform statistical analyses. A random-effects model was used to calculate pooled odds ratios (with 95% CIs) and weighted mean differences (WMDs [95% CI]) for dichotomous and continuous variables, respectively. RESULTS Eighteen studies with 2815 patients in total were included in the meta-analysis. During spine surgery, the use of intraoperative cell salvage did not reduce the intraoperative (OR 0.66 [95% CI 0.30, 1.41]), postoperative (OR -0.57 [95% CI 0.20, 1.59]), or total transfusion (OR 0.92 [95% CI 0.43, 1.98]) rate. There was a reduction in the number of allogenic units transfused intraoperatively by a mean of 0.81 (95% CI -1.15, -0.48). However, there were no differences in the number of units transfused postoperatively (WMD -0.02 [95% CI -0.41, 0.38]) or the total units transfused (WMD 0.08 [95% CI -1.06, 1.22]). There were also no differences in operative time (WMD 19.36 [95% CI -2.43, 42.15]) or complications reported (OR 0.79 [95% CI 0.46, 1.37]) between groups. A difference in postoperative hemoglobin (WMD 0.54 [95% CI 0.11, 0.98]) between both groups was observed. CONCLUSIONS Cell saver is efficacious at reducing intraoperative allogenic units transfused. There is no difference in transfusion rates, postoperative units transfused, and the total number of units transfused. Further cost analysis studies are necessary to evaluate the cost-effectiveness of this method of blood conservation. CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: meta-analysis; strength of recommendation: low.
PICO Summary
Population
Patients undergoing spine surgery (18 studies, n=2815).
Intervention
Use of intraoperative cell salvage.
Comparison
Control.
Outcome
The use of intraoperative cell salvage did not reduce the intraoperative, or total transfusion rate. There was a reduction in the number of allogenic units transfused intraoperatively by a mean of 0.81. However, there were no differences in the number of units transfused postoperatively or the total units transfused. There were also no differences in operative time or complications reported between groups. A difference in postoperative hemoglobin between both groups was observed.
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Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage
Mao Y, Shen Z, Zhu H, Yu Z, Chen X, Lu H, Zhong F, Cheng H
Ann Palliat Med. 2020
Abstract
BACKGROUND To evaluate and analyze the therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage. METHODS Sixty patients with hypertensive cerebral hemorrhage admitted to our hospital from September 2014 to September 2019 were selected for study and randomly divided into study group (n=30) and routine group (n=30) according to admission number. Two groups of patients were given basic treatment after admission, while routine group patients were given small bone window hematoma removal, study group patients were given stereotactic soft channel puncture and drainage, and the clinical effects of the two groups were analyzed. RESULTS The total effective rate of the study group was 96.67%, which was significantly higher than that of the routine group (80.00%), and the difference was statistically significant (P<0.05). The level of independent living in the study group was significantly higher than that in the conventional group, and the level of neurological deficit was lower than that in the conventional group, with statistically significant difference (P<0.05). Before treatment, there was no significant difference in the hematoma volume between the two groups (P>0.05). after treatment for 1, 2 and 4 weeks, the hematoma volume of the two groups decreased, and the hematoma volume of the study group was significantly less than that of the conventional group, with significant difference (P<0.05). There was no difference in CD3+ positive cell rate and CD8+ positive cell rate between the two groups before treatment (P>0.05). After treatment, the CD8+ positive cell rate in the study group was lower than that in the conventional group, and the CD3+ positive cell rate was higher than that in the conventional group, with statistically significant difference (P<0.05). The incidence of postoperative complications such as pulmonary infection, urinary tract infection, liver and kidney dysfunction in the study group was lower than that in the conventional group, and the difference was statistically significant (P<0.05). CONCLUSIONS Stereotactic soft-channel puncture and drainage has the advantages of less trauma, less bleeding, fewer complications and rapid postoperative recovery. It can be used for the treatment of hypertensive cerebral hemorrhage, promote the recovery of neurological function of patients, improve independent living standard and effectively improve prognosis.
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Role of closed drain after multi-level posterior spinal surgery in adults: a randomised open-label superiority trial
Gubin, A. V., Prudnikova, O. G., Subramanyam, K. N., Burtsev, A. V., Khomchenkov, M. V., Mundargi, A. V.
European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2019;28(1):146-154
Abstract
PURPOSE To explore the role of closed suction drain in multi-level posterior spinal surgery. METHODS We performed prospective, open-label, randomised control, superiority trial with parallel design and 1:1 allocation. A total of 161 patients undergoing posterior spinal surgery involving more than one motion segment at a dedicated spine surgery department were randomly allocated into "drain" or "no-drain" groups, based on which surgical drain was employed at the end of surgery. After excluding six cases with intraoperative dural tear, the data of 80 patients in "drain" and 75 patients in "no-drain" group were analysed. Primary outcome was total perioperative blood loss (sum of intraoperative blood loss, volume of drain if present and volume aspirated if patient developed collection in relation to surgical wound). The secondary outcomes were transfusion requirements, wound healing and complications. RESULTS Both groups were comparable with respect to baseline characteristics. Total perioperative blood loss was significantly higher in "drain" group (716 ± 312.97 ml vs 377.9 ± 295.72 ml, p < 0.0001). Number and volume of post-operative aspirations were significantly higher in "no-drain" group whereas transfusion requirements were significantly higher in "drain" group. Except for one case of superficial wound inflammation in either group, there were no complications. Subgroup analysis revealed that the results were applicable for surgeries involving "two/three" levels and "more than three" levels. CONCLUSIONS The practice of not using closed surgical drains after multi-level posterior spinal surgery reduces post-operative blood loss and transfusion requirements. But this comes with the disadvantage of increased wound soakage and need for post-operative wound aspirations. The risks of benefits of "drain" and "no drain" must be carefully weighed and an informed choice be taken. These slides can be retrieved under Electronic Supplementary Material.
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Post-Operative Blood Salvage and Autotransfusion for Adult Spinal Deformity: A Randomized Controlled Trial
Nemani VM, Kim HJ, Mina CA, Sheha ED, Ross T, Boachie-Adjei O
Spine. 2019
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE To determine whether post-operative blood salvage and autotransfusion vs. traditional closed suction drainage reduces the rate of homologous blood transfusions in patients undergoing surgery for adult spinal deformity. SUMMARY OF BACKGROUND DATA The use of intra-operative blood salvage has become commonplace in spine surgery; however, the collection and reinfusion of blood drained from the wound post-operatively has not been employed routinely due to increased cost and questionable benefit. METHODS Adult patients undergoing long posterior fusions were randomized to either a blood salvage and reinfusion system (OrthoPat - Group 1) or a standard subfascial closed suction drain (Group 2). Blood collected in Group 1 was reinfused according to the manufacturer's protocol. Reinfusion drains were converted to standard closed suction drains when output was less than 50cc over 4 hours, and drains were removed when output was minimal. Patients received autologous or homologous blood transfusions when Hg < 8 g/dL or they had symptomatic anemia. RESULTS 34 patients were randomized into Group 1 and 36 patients into Group 2. There were no differences in pre-operative or intra-operative parameters. Patients in Group 1 had higher hemoglobin levels on POD #2 and POD #3 compared to those in Group 2. However, there was no significant difference in the percentage of patients requiring homologous blood transfusion between the two groups (41% Group 1 vs. 60% Group 2, p = 0.17). Similarly a subgroup analysis in patients with EBL > 2000cc also showed no difference in homologous blood transfusion rates (67% Group 1 vs. 76% Group 2, p = 0.58). There were no differences in the rate or type of post-operative complications. CONCLUSIONS Post-operative blood salvage and reinfusion results in a higher hemoglobin level in the early post-operative period, but does not significantly reduce the need for homologous blood transfusion. LEVEL OF EVIDENCE 1.