Evaluation of Autologous Blood in Pterygium Surgery With Conjunctival Autograft
PURPOSE Autologous blood has been used exploratively with conjunctival autograft in pterygium surgery. However, it is controversial whether autologous blood performed better than other fixation methods, including fibrin glue and sutures. This meta-analysis was conducted to evaluate the effectiveness of using autologous blood in pterygium surgery with conjunctival autograft. METHODS The study was conducted according to the PRISMA guidelines. The MEDLINE, Cochrane library, and Embase databases were systematically searched from their establishment until April 1, 2018. Randomized controlled trials comparing autologous blood with fibrin glue/suture in pterygium surgery with conjunctival autograft were included. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. Outcome measurements were recurrence, graft displacement, graft retraction, and surgical duration. Review Manager 5.3 (Cochrane Community, Cochrane Collaboration, London, UK) was used to perform the statistical analysis. When I < 50%, statistical heterogeneity was considered acceptable, and a fixed-effects model was adopted; alternatively, the random-effects model was used. RESULTS Seven randomized controlled trials including 516 patients were finally included in the meta-analysis. Four studies with 379 patients compared autologous blood and fibrin glue. Autologous blood was inferior to fibrin glue with respect to surgical duration, graft retraction, and graft displacement. However, there was no statistical difference between the 2 groups in terms of the recurrence rate. Four studies with 152 patients compared autologous blood and traditional suturing. Autologous blood was superior to sutures in terms of surgical duration and inferior to sutures in terms of graft retraction. No difference was detected in terms of graft displacement and recurrence rate. CONCLUSIONS In conclusion, autologous blood is an appropriate method for graft fixation in pterygium surgery. Current research suggests that autologous blood derivatives may be a promising approach after pterygium excision. However, this requires further confirmation.
Could post-thyroidectomy bleeding be the clue to modify the concept of postoperative drainage? A prospective randomized controlled study
Asian Journal of Surgery. 2017;41((5):):511-516
BACKGROUND/OBJECTIVE To unveil the real effect of surgical drains on the outcomes of thyroidectomy for benign thyroid disorders. METHODS A prospective randomized study was conducted at Abha Private Hospital, Saudi Arabia on 108 patients suffered from benign thyroid disorders undergoing elective thyroidectomy from 1 August 2015 to 28 February 2017. Patients were allocated randomly into drainage group (A) and non-drainage group (B). The demographic data, operation (type and duration), postoperative complications, histopathological results and length of stay were assessed, documented and statistically verified to check its significance. RESULTS A total of 108 patients were enrolled in the study; 94 females and 14 males with mean age of 38.02 years, two patients developed hematoma (1.85%); one in each group and another two patients had seroma with no significant difference between both groups, the mean length of stay was significantly higher in group (A) (p = 0.001). CONCLUSION This prospective study verified that routine drainage adds no significant advantage in the prevention of post-thyroidectomy bleeding, but it prolongs hospitalization. This aids in changing the concept from the "wide" use of drains into the "wise" use in selected patients with risk factors of bleeding.
Are cell salvage and autologous blood transfusion safe in endonasal surgery?
Otolaryngology - Head & Neck Surgery. 2010;142((3, Suppl 1):):S3-6.
OBJECTIVE Endoscopic transnasal approaches to the skull base and intracranial disease are an emerging subspecialty. The limits of this approach are often dictated by exposure and blood loss. Cell salvage techniques are widely used in other surgical fields. However, in otolaryngology, questions remain regarding its safety because work is performed in a contaminated field. In this literature review, we present the evidence for perioperative cell saver blood transfusion in potentially contaminated fields and the need for further investigation of its use in endonasal surgery. DATA SOURCES MEDLINE and Evidence Based Medicine Reviews databases were searched for relevant articles. REVIEW METHODS All English articles discussing autologous blood transfusion in endonasal surgery were reviewed. RESULTS Despite a wide search pattern, no articles that discuss this topic were found in the English literature. Therefore, we went on to present data on the general use of cell saver blood in contaminated fields. CONCLUSION Cell saver blood is widely accepted in surgery. It offers many advantages in elective operations in which blood loss is expected to be significant. Cell saver blood has been transfused from contaminated fields in other forms of surgery without an associated increase in morbidity. There is good evidence that antibiotic prophylaxis is mandatory in this setting. There is no direct evidence that cell salvage blood is safe in endonasal surgery. Cell salvage is part of a multimodality approach, including the use of hypotensive anesthesia, topical procoagulants, a dedicated team with appropriate equipment, and a good surgical technique with a focus on hemostasis.
Place of normovolemic hemodilution in oncologic cervicofacial and ENT surgery French
Annales Francaises d Anesthesie et de Reanimation. 2002;21((4):):271-5.
OBJECTIVE Evaluate the use of normovolaemic haemodilution in cervico-facial oncologic surgery. STUDY DESIGN Prospective, randomised, simple blinded study. PATIENTS AND METHODS 38 ASA I and II patients were studied: a control group (n = 21) and a haemodilution group (n = 17) in whom 5.5-8 mL.kg-1 blood were withdrawn before induction, replaced by an equivalent amount of colloids. In both groups, the transfusional strategy was to keep the haemoglobin level above 100 g.L-1 throughout the procedure and the recovery phase, using in priority the autologous blood in the haemodilution group. Blood losses during surgery were evaluated by weighing the sponges and by measuring the aspirated blood. RESULTS Demographic and anaesthetic data, and blood losses were similar. The haemoglobin levels dropped significantly in the haemodilution group (138 +/- 10 g.L-1 to 107 +/- 11 g.L-1) as well as in the control group (131 +/- 11 g.L-1 to 110 +/- 10 g.L-1). Infectious complications were slightly higher in the haemodilution group, although this difference did not reach the level of significance. CONCLUSION Normovalaemic haemodilution does not seem to be indicated in cervico-facial and ENT oncologic surgery.
Autologous versus homologous transfusion in cervico-fascial oncologic and ENT surgery French
Tunisie Medicale. 2001;79((3):):146-51.
The objective was to evaluate the interest of the normovolemic hemodilution (NVH) in cervico-facial oncologic and ENT surgery. It was a prospective, randomised and simple blind study having included A(n = 17) having benefitted before induction of a blood withdrawal of 6-8 ml.kg-1, substituted by an intravenous drip of colloid. B group (n = 21). The transfusional objective having been to assure for the two groups, during operative and in postoperative periods, a rate of Hb > or = 10 g.dl-1 and a rate of Ht > or = 30%. The two groups were comparable for the demographic and anesthetic characteristics, and the blood losses during operative period. A variation significantly more important between before and postoperative hemoglobin has been objectified in the group A. The infectious morbidity was significantly more elevated in the group A (23.5% versus 4%). The cost was distinctly more elevated in the hemodiluted group. The NVH doesn't seem to be an indication of choice in the cervico-facial and ENT oncologic surgery.
Role of acute normovolemic hemodilution in treating retinal venous occlusions . French
Annales Francaises d Anesthesie et de Reanimation. 1986;5((3):):229-33.
The supposed state of retinal venous occlusions by a thrombus has led to the use of diverse antithrombotic treatments (heparin, fibrinolytic agents). This theory being considered at the moment as controversial, haemorheological theories being more particularly favoured, other treatments are proposed in an attempt to better retinal microcirculation, and this by changing the blood viscosity parameters. The study reported here compared the effects on recovery of visual acuity of retinal venous occlusion patients of anticoagulant treatment alone, haemodilution alone, or both together. After initial ophthalmic assessment, twenty-five patients were randomly assigned to one of three groups: group I (n = 5; mean age 62 +/- 14 yr) received heparin for 21 days, followed by antivitamin K drugs for a further 30 days; group II (n = 10; mean age 54 +/- 16 yr) were acutely hemodiluted with 40,000 daltons molecular weight dextran, bringing the haematocrit to between 0.25 and 0.30; on day 2, the same anticoagulant treatment as in group I was associated; group III (n = 10; mean age 58 +/- 18 yr) were only hemodiluted. The hemodiluted state was maintained for 21 days. A biological assessment was carried out for the three groups on days 1, 2, 7, 14, 21 and 30 (haematocrit, fibrinogen level, platelet count, kaolin-cephalin time, heparin level). The evolution of visual acuity was assessed on days 7, 14, 21, 30, 60 and 90. Mean visual acuity was assessed on days 7, 14, 21, 30, 60 and 90. Mean visual acuity was virtually the same for the three groups on day 0.(ABSTRACT TRUNCATED AT 250 WORDS)