Role of tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries

Pharmacological agents are used to reduce postoperative blood loss. To assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major hip and femoral surgeries. A prospective, randomized, double blinded study was conducted in the tertiary care teaching hospital. Ninety ASA grade I-II patients undergoing hip fracture surgery were included in this prospective study. Forty-five patients received tranexamic acid [TA] given in a bolus dose of 500 mg 15 min before surgical incision followed by continuous infusion. The remaining, 45 patients were allocated as a control group. Postoperative bleeding [volume of blood in the drain], percentage fall of hemoglobin, transfusions and complications were recorded. Mean volume of blood in the drain was 39.33 +/- 10.09 ml [mean +/- SD] as compared to 91.11 +/- 17.61 ml in placebo group showing a P<0.001. Mean percentage fall in Hb at day 0 was 2.99 +/- 3.45 in the study group as compared to 7.70 +/- 6.05 in the placebo group [P<0.001], and fall at day 2 in the study group was 0.35 +/- 0.74, compared to 2.72 +/- 2.70 in the placebo group [P<0.001]. The number of patients required blood transfusions were lower in the study group than in the placebo group [P=0.01]. We conclude that tranexamic acid significantly reduces postoperative blood loss and transfusion requirements during major hip and femoral surgeries

Comparison of clonidine versus midazolam in monitored anesthesia care during ENT surgery: a prospective, double blind, randomized clinical study

Monitored anaesthesia care [MAC] typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs which is a common practice during various ENT surgical procedures. To compare the effectiveness and safety profile of clonidine against midazolam as an intravenously administered agent for MAC. Settings and design: Randomized, double blind, prospective study. Sixty patients undergoing ENT surgery under MAC were divided into two groups of 30 patients each. The patients in Group C received clonidine 2 mcg/kg IV and in Group M received midazolam 20 mcg/kg IV over 10 min. Ramsay sedation score, requirement of intraoperative rescue sedation [propofol] and analgesic [diclofenac infusion], postoperative visual analogue score and analgesic requirement [tramadol], adverse effects, recovery profile [Aldrete Score] and satisfaction scores of patients and surgeon were recorded. Data were analysed by chi-square, student t test and analysis of variance using Epi info 6 with p value <0.05 as significant. Mean Ramsay sedation score [RSS] was significantly more in Group M [2.50 +/- 0.73] as compared to Group C [1.80 +/- 0.85], p = 0.001. Intraoperative rescue sedation with propofol infusion [if RSS<3] was required by significantly higher number of patients in Group C [n=19, 63.4%] than in Group M [n=6, 20%], P=0.001. Intraoperative rescue analgesic requirement was significantly more in Group M [n =21, 70%] as compared to Group C [n=11, 36.6%], p=0.009. Intraoperative bleeding score was significantly less in Group C [1.93 +/- 0.80] than in group M [2.43 +/- 0.73], P=0.014. Postoperative VAS score was also significantly less in Group C than in Group M [2.28 +/- 1.9 vs. 3.28 +/- 1.81, P=0.041]. Both patients and surgeon were more satisfied in Group C than in Group M [p=0.010 and 0.019 respectively]. All patients had Aldrete score of 10 at the end of surgery in both groups. We conclude that clonidine along with rescue sedation using propofol infusion can be a better alternative to midazolam in MAC since it provides a calm patient with better intraoperative and postoperative analgesia, and a bloodless surgical field leading to increased satisfaction of both patient and surgeon