1.
The perioperative efficacy and safety of tranexamic acid in adolescent idiopathic scoliosis
Zhong J, Cao K, Wang B, Zhou X, Lin N, Lu H
World neurosurgery. 2019
Abstract
OBJECTIVE To evaluate the efficacy and safety of tranexamic acid (TXA) in patients with adolescent idiopathic scoliosis (AIS) undergoing correction surgery. METHODS A literature search of PubMed, Embase, and Cochrane Library was performed to identify studies published from inception to February 2019. After study selection and data extraction, statistical analysis was performed with RevMan 5.3. The odds ratios (ORs) and weight mean differences (WMDs) with 95% confidence intervals (CIs) for all available clinical outcomes were analyzed using fixed or random effects models. RESULTS A total of 12 studies involving 2500 patients were included. Intravenous TXA use was associated with significantly fewer patient received blood transfusion [OR, 0.12; 95%CI, 0.06 to 0.22; P < 0.001], less intraoperative estimated blood loss (EBL) [WMD, -470.07; 95%CI, -645.23 to -294.90; P < 0.001], less intraoperative EBL per segment [WMD, -27.40; 95%CI, -32.80 to -22.00; P < 0.001], less cell salvage blood transfusion [WMD, -106.02; 95%CI, -170.84 to -41.20; P = 0.001], and shorter surgical time [WMD, -26.18; 95%CI, -46.91 to -5.46; P = 0.010]. No significant difference was found in postoperative hemoglobin [WMD, 0.39; 95%CI, -0.07 to 0.86; P = 0.100] and hemoglobin change [WMD, -0.92; 95%CI, -2.90 to 1.07; P = 0.360] between the TXA group and the control group. No renal, thromboembolic, or other major complications associated with TXA were noted in included studies. CONCLUSIONS TXA was effective in reducing surgical time, intraoperative EBL and blood transfusion without increasing complications in patients undergoing correction surgery for AIS. However, TXA have no influence on postoperative hemoglobin and hemoglobin change.
2.
Evaluation of the quality of processed blood salvaged during craniotomy
Liang H, Zhao Y, Wang D, Wang B
Surgical Neurology. 2009;71((1):):74-80.
Abstract
BACKGROUND The objective of the study was to evaluate the quality of salvaged blood retrieved during craniotomy after the processing by autotransfusion devices and to compare the processing effects of 2 autotransfusion devices: ZITI-2000 (Jingjing Medical Equipment Limited, Beijing, PR China) and BRAT 2 (Cobe Cardiovascular Inc, Division of Sorin Biomedica Arvada Co, Arvada, Colo). METHODS Twenty-four patients scheduled for elective craniotomy were randomly allocated into 2 groups, and 1 of the 2 autotransfusion devices (ZITI-2000 and BRAT 2) was used for each group. The blood samples were collected, washed, and tested for select blood components. The efficacy of centrifugation and washing was assessed by determining the ER of PLTs, WBCs, K+, and fHb. The morphology of the washed erythrocytes and the 2-week-old PRBCs was evaluated by means of SEM. RESULTS Extensive hemolysis was observed in the collected blood of both ZITI-2000 and BRAT 2 groups, with fHb being 464. 8 +/- 111. 6 and 459. 0 +/- 91. 6 mg/dL, respectively. The ERs of PLTs, WBCs, K+, and fHb were >35%, >80%, >90%, and >90%, respectively. Although some shape-changed red cells were observed in the washed blood, discocytes were the dominant form in both groups, with the percentages of discocytes being 58. 0% +/- 8. 0% and 59. 7% +/- 8. 3%, respectively. A greater number of shape-changed red cells were found in 2-week-old PRBCs (P < . 01). CONCLUSION For craniotomies, the quality of salvaged blood processed by both devices (ZITI-2000 and BRAT 2) is equally satisfactory. Although extensive hemolysis is noted in the salvaged blood, IBS can be effectively and safely used.