Evaluation of the effect of tranexamic acid and postoperative blood loss in open heart surgery

Background: The effective dose of Tranexamic Acid (TA) is unclear in reducing blood loss after cardiac surgery. In Vietnam, the doses of TA 10mg/kg for starting anaesthesia, 5mg/kg for transfusion into extracorporeal circulation solution, then using a maintained dose of 1mg/kg/gi\u1edd reduces blood loss and transfusion, but there is no statistical significant. Objectives: To evaluate blood loss and need for transfusion after cardiac surgery in patients receiving TA 20 mg/kg at induction + 10 mg/kg in extracorporeal circulation solution and 2 mg/kg/1h for maintenance; To evaluate coagulation profile after TA. Subject and methods: A double blind randomly controlled trial is conducted in 80 surgical cardiac patients equally divided into TA and control groups: Results: In the TA group, the post - operative blood loss is 393.50 \xb1 136.64 ml, Hematocrit (Hct) 35.31 \xb1 3.38 % with less individuals and smaller amount of blood and/or frozen fresh platelets needed than in control (p<0.001). Conclusions: An above dose of TA reduces approximately a half of blood loss and elevates Hct postoperatively, with significant lower requirements of transfusion than the control and higher amount of platelets, reduced D-dimers (p<0.05) and unchanged Fibrinogen, PT, INR and aPTT (p >0.05).

Role of LMA \u2013 Proseal in anesthesia for laparoscopic surgery

Background: Is Laryngeal Mask Airway (LMA) Proseal superior over Endo Tracheal Tube (ETT) in anesthesia for laparoscopic surgery? Objective: (1) To evaluate the effect of LMA Proseal on blood pressure, heart rate and respiration in laparoscopic surgery. (2) To evaluate the surgical condition and side effects of LMA Proseal. Subject and Method: A single blind control study was done for 60 patients at Viet Duc Hospital. Patients were divided into 2 groups: LMA Proseal group (30 patients) and control group (30 patients). Blood pressure, heart rate, SpO2, PetCO2, Pmax and Vh were monitored after laparoscopic surgery. Results: Compared with ETT, LMA Proseal attenuates the increase in blood pressure and heart rate; SpO2, PetCO2, Pmax and Vh are stable within safe limits like ETT. Conclusions: LMA Proseal provides stability for blood pressure, heart rate and respiration while facilitating surgical conditions and reducing postoperative side effects.

Effectiveness evaluation of Boussignac Continuous Positive Airways Pressure (CPAP)on the treatment of Acute Hypoxemic Respiration Failure (AHRF) after open cardiac surgery

Introduction: Boussignac CPAP has recently been considered as an alternative to mechanical ventilation for AHRF after open cardiac surgery. Objectives: The study aims to: 1) Evaluate the effectiveness of Boussignac CPAP on clinical profile and arterial blood gases in treating AHFR after cardiac surgery. 2) Identify the success rate and adverse effects of Boussignac CPAP. Subjects and method: Controlled clinical trial included 35 patients with AHRF after open cardiac surgery. Patients were treated by Boussignac APCP. Measurements of MAP, HR, RR, PaO2, PaO2/FiO2 and PaCO2 before and after procedure were compared. Duration, success rate and disadvantages of Boussignac CPAP were noted. Results: MAP, HR, RR measurements were stabilised gradually. ABGs just before, at 30, 60 minutes after and at the end of procedure revealed as following: PaO2 increased from 71.6 to 148.3 to 155.8 to 166.1mmHg; PaO2/FiO2 increased from 208.3 to 297.4 to 311.8 to 332.9mmHg. PaCO2 decreased from 52.7 to 38.6 to 37.1 to 35.3mmHg (p<0.001). The duration of Boussignac CPAP ranged from 2.09+/-0.5 to 51.2+/-14.1h, dependent on AHRF causes. The success rate was 97.1% with minor adverse effects. Conclusion: Boussignac CPAP can be considered as a safe procedure with high success rate. It can improve significantly MAP, HR, RR, oxygenation (PaO2, PaO2/FiO2) and ventilation (PaCO2). The duration of Boussignac CPAP in patients with hemodynamic-originated AHRF was significantly shorter than that in patients with nonhemodynamic-originated AHRF.

Role of trendelenburg 300 test for diagnosing the hypovolemic status in cardiac surgery

Background:Hypovolemia is a common cause of hypotension and low cardiac index (CI) in cardiac surgery but no hemodynamic parameters reflect this status well. The accurate diagnosis of hypovolemia is important because the wrong treatment will cause ineffectiveness and bad consequences such as severe heart failure, pulmonary edema, ... Objectives: To evaluate the performance of diagnostic characteristics of the trendelenburg 300 test for hypovolemia in cardiac surgery. Subjects and method: The prospective, cross \ufffd?sectional and randomized controlled trial (RCT) study was conducted on 30 patients (18 males, 12 females and average age 47,17 \xb1 13,93) undergoing valvular repair/replacement or coronary revascularization. The Swan \ufffd?Ganz catheters were placed in 20 patients and PiCCO catheters in 10 patients. Trendelenburg 300 test is considered positive if blood pressure (BP), central venous pressure (CVP), CI and intrathoracic blood volume (ITBV) increase. Results: The hypovolemic status in cardiac surgical patients is diagnosed if BP and/or CI increase in trendelenburg 300 position (Se 87.5% and 65.63%; Sp 100% and 75%, area under ROC 0.83 and 0.81, respectively). Conclusion: The increases in BP and CI responding to trendelenburg 300 position are good indicators of hypovolemia in cardiac surgery.

Erythrocyte transfusion to compensate for blood loss in operation in adult

Erythrocyte transfusion is an important treatment for some operation. However, it may cause risks of infection, immunal changes, especially HIV and hepatitis C infection. There were some questions for this procedure including indications for intraoperative erythrocyte transfusion, (hematocrite or hemoglobine). Blood dilution, host-blood transfusion, quality of erythrocyte, recombined erythropoietin and substitution indication.