ABSTRACT
Abstract Objective To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique. Methods Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019. Results Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and pre-eclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method. Conclusion The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.
Resumo Objetivo Descrever a experiência clínica com a técnica de B-Lynch no manejo da hemorragia pós-parto e os fatores relacionados à indicação da técnica bem como apresentar as taxas de sucesso da aplicação da técnica de B-lynch. Métodos Estudo observacional, retrospectivo, de corte transversal e analítico. Os dados foram obtidos por estudo de prontuário. A população do estudo foi constituída de pacientes submetidas à sutura hemostática com a técnica de B-Lynch, sendo incluídas 104 pacientes dentro do período de 01 de janeiro de 2005 a 31 de dezembro de 2019. Resultados Do total de 104 pacientes, 82,7% não apresentaram qualquer complicação. A transfusão de sangue e a internação na UTI foram as complicações mais prevalentes, com 13,5% e 15,4%, respectivamente. Apenas 1% teve infecção puerperal e do sítio cirúrgico. Os fatores mais relacionados com a aplicação da técnica foram a presença de cesárea anterior (30,8%), uso de ocitocina (16,3%) e pré-eclâmpsia (11,6%). A histerectomia puerperal foi realizada em 4,8% das pacientes por falha do método. Conclusão A experiência clínica com a técnica de B-Lynch foi satisfatória, pois apresentou poucas complicações, com excelentes resultados no controle hemorrágico. A cesárea anterior, o uso de ocitocina e a pré-eclâmpsia se destacaram como fatores relacionados à indicação da aplicação da técnica. A taxa de sucesso avaliada foi de 95,2%.
Subject(s)
Humans , Female , Pregnancy , Postpartum Hemorrhage/surgery , Cesarean Section/adverse effects , Cross-Sectional Studies , Retrospective Studies , Suture TechniquesABSTRACT
ABSTRACT Purpose: In this study, hemostatic efficacy of Ankaferd Blood Stopper (ABS), a new generation hemostatic agent, was compared in the presence of heparin effect. Methods: Forty-eight Wistar albino rats were divided into two main groups as heparinized and nonheparinized, and these two main groupswere divided into six subgroups as control, Surgicel and ABS (n = 8). Grade 2 liver injury was performed on rats as standard. All groups were compared in terms of weight, laceration surface area, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), bleeding time, bleeding amount, hemoglobin (Hb) levels, macroscopic and microscopic reactions to the agent used. Results: Whereas there was no statistically significant difference between weight, laceration surface area, PT, INR and preoperative Hb values in the heparinized and nonheparinized groups, postoperative Hb, bleeding time, bleeding amount and aPTT values were statistically different (p < 0.05). In the heparin-hemostat interaction, the ABS group had the lowest bleeding in the heparinized group in terms of the amount of bleeding compared to the control and Surgicel groups (F = 0.764; p = 0.047). In macroscopic and microscopic comparison, there was no difference between the groups in terms of cell necrosis andfresh bleeding (p > 0.05), it was found that the Surgicel group had statistical significantly higher reaction scores (p < 0.05) than the other groups in terms of other parameters. Conclusions: Ankaferd Blood Stopper can be safely and effectively used in surgical practice and in patients with additional diseases requiring heparinization, since it causes minimal reaction in the liver and decreases the amount of bleeding especially in the heparinized group.
Subject(s)
Humans , Animals , Rats , Hemostatics , Plant Extracts/therapeutic use , Rats, Wistar , LiverABSTRACT
Os retalhos interpolados têm sido um dos mais importantes e funcionais retalhos no arsenal da cirurgia plástica reconstrutiva, tornando-se uma opção segura mesmo nos casos mais difíceis. O pedículo do retalho interpolado necessita de curativo para evitar sangramento e a contaminação local. Este curativo frequentemente falha na prevenção de pequenos sangramentos que ocorrem durante as primeiras 24-48 horas, forçando a troca recorrente do mesmo, em média de três a cinco trocas. A técnica proposta neste trabalho consiste na aplicação direta de uma camada de GELFOAM®, envolto por gaze petrolizada, para prevenção do sangramento da área cruenta do pedículo do retalho, acarretando melhor hemostasia e menos manipulação do pedículo vascular.
Interpolated flaps are among the most important and functional flaps in reconstructive plastic surgery, representing a safe option even in the most difficult cases. The pedicle of the interpolated flap requires a dressing to avoid bleeding and local contamination. This dressing often fails to prevent minor bleedings, which occurs within the first 24-48 hours. As a result, it needs to be continuously changed, from three to five times on average. The technique proposed in this study consists in a direct application of a GELFOAM® layer. This is subsequently wrapped with petroleum gauze to prevent bleeding of the open area in the pedicle flap, improving hemostasis and reducing the manipulation of the vascular pedicle.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , History, 21st Century , Postoperative Complications , Surgical Flaps , Therapeutics , Bandages , Postoperative Hemorrhage , Diffusion of Innovation , Hemostasis , Hemostasis, Surgical , Postoperative Complications/therapy , Surgical Flaps/surgery , Therapeutics/methods , Bandages/adverse effects , Postoperative Hemorrhage/surgery , Postoperative Hemorrhage/therapy , Hemostasis/drug effects , Hemostasis, Surgical/methodsABSTRACT
OBJETIVO: Avaliar o benefício clínico e econômico de TachoSil® comparado a técnicas convencionais para hemostasia em cirurgias hepáticas, pulmonares e renais. MÉTODOS: Realizou-se revisãoda literatura em busca de revisões sistemáticas e ensaios clínicos randomizados (ECRs) que comparassem TachoSil® a técnicas convencionais de hemostasia nas cirurgias hepáticas, pulmonares erenais. Foi realizada análise de custos, sob a perspectiva do Sistema Suplementar de Saúde, contemplando custos de materiais, tempo de internação e transfusão de hemoderivados. No cenário base o uso de recursos foi baseado em estudo econômico e no cenário alternativo, nos ECRs originais. RESULTADOS: Foram encontrados 142 estudos, sendo selecionados 6 ECRs avaliando TachoSil® em cirurgia pulmonar, 4 em cirurgia hepática e 2 em cirurgia renal, além de 4 revisões sistemáticas e 2estudos não randomizados considerados relevantes. Os resultados de todos estes estudos consideraram TachoSil® uma boa alternativa às técnicas convencionais. Com base nos ECRs, TachoSil® é capaz de reduzir o tempo de internação após cirurgia pulmonar em 1,49 dia (IC 95%: 0,52 - 2,45,p<0,003) e, após cirurgia hepática, em 3 dias. A análise de custos demonstrou que TachoSil® reduz o custo em R$10.349,77, R$10.686,11 e R$4.677,46, respectivamente, nas cirurgias pulmonar, hepática e renal, quando comparado às técnicas convencionais, no cenário base. No cenário alternativo as reduções foram de R$2.020,09, R$4.872,22 e R$3.997,17 nas indicações pulmonar, hepática e renal, respectivamente. CONCLUSÕES: O maior benefício clínico de TachoSil®, quando comparado a técnicas convencionais, foi demonstrado em diversos estudos clínicos. O uso de TachoSil® levou a reduções de custo, mostrando-se uma alternativa cost-saving em relação às técnicas de hemostasia convencionais, com maior eficácia e menores custos
OBJECTIVE: To evaluate the clinical and economic benefit of TachoSil® for hemostasis in liver, lung and kidney surgery compared to conventional techniques. METHODS: A literature review was conducted looking for systematic reviews and randomized controlled trials (RCTs) that compared TachoSil ® to conventional techniques for hemostasis in liver, lung and kidney surgeries. A cost analysis was performed under the perspective of the Brazilian Private Healthcare System, considering costs of materials, hospitalization and blood transfusions. At the base case scenario, the resources were based on an international economic evaluation and in the alternative scenario, on the original RCTs. RESULTS: The review shows up 142 studies. Six RCTs evaluating TachoSil® in pulmonary surgery, 4 inhepatic surgery and 2 in renal surgery were selected, besides 4 systematic reviews and 2 non-randomized studies that had been considered relevant. The results of all those studies confirmed TachoSil® as a good alternative to conventional techniques. Based on the RCTs, TachoSil® might reduce the period of hospitalization after pulmonary surgery in 1.49 day (95% CI: 0.52 - 2.45), p<0.003) and in 3.00 days after hepatic surgery. The cost analysis demonstrated that, when compared to conventional techniques in base case, TachoSil® reduces the costs of lung, liver and kidney surgeries in $10,349.77, $10,686.11 and $4,677.46. In the alternative scenario the reductions might be of $2,020.09 $4,872.22 and $3,997.17 in lung, liver and renal surgeries, respectively. CONCLUSIONS: The superior clinical benefit of TachoSil® when compared to conventional techniques was demonstrated in several clinical trials. The use of TachoSil® leads to cost reductions, being a cost-saving alternative (with superior efficacy and lower costs)
Subject(s)
Humans , Costs and Cost Analysis , Hemostasis, Surgical , Surgical Procedures, Operative , Tissue AdhesivesABSTRACT
O sangramento durante procedimentos cirúrgicos diversos podem aumentar o tempo operatório e também pode comprometer a visibilidade do cirurgião e o próprio procedimento. A opção pelo uso de um tipo de agente hemostático é guiada por indicações precisas, fornecidas principalmente por resultados de estudos experimentais e clínicos. O objetivo deste artigo é possibilitar de forma didática o conhecimento desses agentes hemostáticos e adesivos teciduais que podem ser utilizados como alternativas no intuito de fazer hemostasia, vedações e junção de tecidos...
Subject(s)
Humans , Tissue Adhesives , Cyanoacrylates , Hemostasis , Hemostasis, SurgicalABSTRACT
BACKGROUND: The efficacy of saline-coupled bipolar sealing devices in joint arthroplasty is uncertain, and the utility in simultaneous bilateral total knee arthroplasty (TKA) has not been reported. METHODS: This study compares the use of bipolar sealing and conventional electrocautery in 71 consecutive patients. The experimental and control groups were matched for age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, and preoperative hemoglobin. Variables of interest included blood loss, transfusion requirements, and operative characteristics. RESULTS: In comparison to patients treated with conventional electrocautery, those treated with the bipolar sealer were 35% less likely to require transfusion. The median number of transfusions per case was also significantly lower in the experimental group. Hemoglobin change, total blood loss, and length of stay were not significantly different between the groups. The experimental group had longer operative times. CONCLUSIONS: Bipolar sealing shows promise as a blood loss reduction tool in simultaneous bilateral TKA. The marginal savings attributed to reduced transfusion rates with use of the bipolar sealer did not exceed the additional per-case expense of using the device. The decision to use the device with the goal of less blood loss must come with the additional expense associated with its use.
Subject(s)
Adult , Female , Humans , Male , Arthroplasty, Replacement, Knee , Blood Loss, Surgical/prevention & control , Catheter Ablation/instrumentation , Electrocoagulation/instrumentationABSTRACT
Nos últimos dez anos os agentes hemostáticos e os adesivos teciduais têm sido usados frequentemente e são uma alternativa positiva para evitar a perda sanguínea excessiva. O objetivo dessa revisão é discutir as características de cada um desses agentes para facilitar a decisão do cirurgião na escolha do produto mais adequado para cada tipo de sangramento e natureza da hemorragia. Uma pesquisa da literatura sobre o assunto, nas línguas inglesa e portuguesa, foi conduzida usando o PubMed (www.pubmed.com) e Google (www.google.com.br) para encontrar artigos recentes sobre o tema. Com base nestes estudos, os autores fizeram uma revisão didática sobre os agentes hemostáticos e adesivos teciduais e concluem que existe um agente hemostático a ser usado em cada cenário específico.
In the last ten years the hemostatic agents and tissue adhesives have been frequently used and they are positive alternatives to prevent excessive blood loss. The objective of this review is to discuss the characteristics of each of these agents to facilitate the surgeon's decision when choosing the most suitable product for every type of bleeding and nature of hemorrhage. A survey of the literature on the subject, in English and in Portuguese, was conducted using PubMed (www.pubmed.com) and Google (www.google.com.br) to find recent articles on the topic. Based on these studies, the authors conducted a didactic review on the hemostatic agents and tissue adhesives and concluded that there is a hemostatic agent to be used in each specific scenario.
Subject(s)
Humans , Hemostatics/administration & dosage , Tissue Adhesives , Administration, Topical , HemorrhageABSTRACT
A cirurgia ginecológica teve um avanço muito significativo nos últimos anos, sobretudo com o surgimento de novas técnicas cirúrgicas minimamente invasivas. A histerectomia vaginal sem prolapso com sistema de selamento de vasos de baixo custo baseia-se na técnica descrita por Heaney, modificada com a utilização de um clamp autoclavável (Marclamp) conectado a um sistema gerador de energia bipolar de selamento de vasos (Maxium - KLS Martin). As vantagens da histerectomia vaginal com sistema de selamento de vasos de baixo custo são: menor tempo cirúrgico, pós-operatório menos doloroso, menor tempo de internação e retorno mais rápido às atividades habituais. A histerectomia vaginal pode ser realizada em regime ambulatorial.
The gynecological surgery had a very significant advance in recent years, over all with the new minimally invasive surgical techniques. The vaginal hysterectomy in nonprolapsed uterus using economic vessel sealer system is based on Heaney modified technique using the Marclamp connected to Maxium (Martin's bipolar vessel sealing system). The advantages of the vaginal hysterectomy with economic vessel sealer system are: less operative time, less post-operative pain, lesser time of internment and faster return to the habitual activities. The vaginal hysterectomy can be realized in ambulatorial hospital care.