The effect of tranexamic acid used for spine surgery on blood loss and transfused volume

BACKGROUND: In this randomized controlled study, we evaluate the effect of tranexamic acid on perioperative blood loss and transfused volume in patients undergoing spine surgery. METHODS: We enrolled and randomly allocated 40 patients scheduled for spine surgery under general anesthesia to either tranexamic group or control group. Tranexamic acid was given to tranexamic group with loading dose 10 mg/kg for 15 minutes followed by continuous infusion at the rate of 1 mg/kg/h. In control group, equivalent volume of normal saline was given with the same manner and rate, until the end of procedure. We examined the total blood loss and transfused volume perioperatively. Also we evaluated hemoglobin, platelet, prothrombin time, partial thromboplastin time and thromboelastography before and after surgery. RESULTS: The groups did not differ significantly. Intraoperative blood loss was 1,130.0 +/-563.9 (mean +/-SD) ml in control group and 1,061.5 +/-509.7 ml in tranexamic group. Blood loss at postoperative 12 h and 24 h were 392.0 +/-222.0 ml, 466.0 +/-323.2 ml in control group and 158.5 +/-100.6 ml, 470.2 +/-232.7 ml in tranexamic group respectively. Transfused volumes at intraoperative and postoperative period were differing significantly (1,300.0 +/-709.3 ml, 800.0 +/-343.3 ml in control group compared to 1,020.0 +/-476.3 ml, 340.0 +/-325.0 ml in tranexamic group). CONCLUSIONS: Loading dose of 10 mg/kg tranexamic acid and followed infusion at 1 mg/kg/h reduce perioperative blood transfused volume during spinal surgery.

Percutaneous Cardiopulmonary Support for Tracheal Stenosis Caused by Thyroid Mass: A case report / 대한마취과학회지

A 76-year-old woman presented with tracheal stenosis caused by a thyroid mass. Her symptoms included dyspnea and wheezing. Cervical computed tomography scans revealed an 8.5 x 7.8 cm sized mass and a trachea with an internal lumen 4.3 mm in diameter. The mass caused marked stenosis and deviation of the airway. However, it was not clear if the tracheal lumen was invaded by the mass. We predicted that airway management would be problematic, even in the absence of invasion. Options for intubation included small sized endotracheal tube, fiberoptic bronchoscopy-guided intubation, high frequency jet ventilation, and percutaneous cardiopulmonary support (PCPS). We decided to use PCPS to reduce the chance of ineffective oxygenation and related complications. After supplementing PCPS with epidural anesthesia, general anesthesia was performed without complications. The patient underwent surgical removal of the mass. PCPS was discontinued on the day of surgery, and after two weeks of uncomplicated mechanical ventilatory support, the patient was discharged home.

Propofol-Remifentanil Anesthesia under Somatosensory Evoked Potential Monitoring: 15 Cases : Case reports

Somatosensory evoked potential (SSEP) monitoring has been used to minimize neurologic morbidity during spine surgery. SSEP monitoring may be affected by technical factor including operation, physiological factor associated with patient and anesthetics used to induce and maintain general anesthesia. Several clinical studies have shown that inhaled anesthetics more decrease the amplitude of SSEP than a narcotic based general anesthesia. We have experienced 15 patients who received spine surgery under balanced anesthesia with propofol, remifentanil and 50% N2O, which is supposed to be another useful anesthesia technique for spine surgery under SSEP monitoring.

Combined Spinal-epidural Anesthesia in a Patient with Severe Thoracic Kyphoscoliosis: A case report / 대한마취과학회지

Kyphoscoliosis is a deformity of the costovertebral skeletal structures characterized by an anterior flexion (kyphosis) and lateral curvature (scoliosis) of the patient's vertebral column.(1)) In kyphoscoliosis, lung volume and compliance is reduced due to the change of vertebral column. The work of breathing is increased by abnormal mechanism of the thorax and by increased airway resistance resulting from small lung volume. Airway management and respiratory problems are common and spinal deformities can cause difficulties with regional anesthesia. We had experienced a successful spinal anesthesia for closed reduction and internal fixation (CRIF) and proximal femoral nail (PFN) of fractured intertrochanteric femur in a patient with extremely severe thoracolumbar kyphoscoliosis.

An Experience of Anesthesia of Congenital Anomaly with Airway Involvement : 46 case report

As the improved medical techniques and environmental changes have increased the frequency of general anesthesia for uncommon congenital anomalies. The airway management for a patient with congenital anomaly gives significant challenges to the anesthesiologist. The purpose of this report is to review the authors' experience with airway management and ventilatory support during the perioperative period in children with congenital anomalies with airway involvement, and to summarize anesthetic implications associated with particular congenital anomalies by literature review. Total 46 cases of general anesthesia for operation of congenital anomalies were performed from January 2000 to August 2005 in our hospital. Most common congenital anomaly is a Down syndrome (17 cases, 37%), and most common cause of surgery is the orthopedic surgery for correction of deformed spine (18 cases, 41%). Direct laryngoscopy was successfully used to establish an airway in 35 (76.1%) cases, whereas 5 (11%) cases required the use of fiberoptic bronchoscopy to establish an airway before surgery.

An Anesthetic Experience for Russell-SilverSyndrome : A case report

We present a 4-years-old Russell-Silver syndrome patient who underwent surgical correction of left auricular abnormality. He had a triangular face with hypoplastic mandible. Because of facial manifestations of this syndrome, the anesthesiologist should prepare for a difficult endotracheal intubation and mask fitting. These patients may be prone especially to hypoglycemia and hypothermia during intraoperative period, therefore close monitoring and appropriate care for hypoglycemia and hypothermia is required. In this case, gentle direct laryngoscopy was performed to assess the airway. Hypoglycemia and hypothermia was not observed. We discuss anesthetic considerations in management.