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Bloodless surgery

C Wapler, P Laronde, G Nedellec, A Aumar, N Sayah, C Fontaine
The ideal finger tourniquet must be easy to use and provide a completely bloodless field with control of the pressure exerted at the compression site. The primary objective of this study was to evaluate the effectiveness of the T-RING™ digital tourniquet in emergency hand surgery; the secondary objective was to define the optimal indications and possible contraindications. This prospective study, undertaken between May 4 and July 30, 2015, comprised the application of 100 finger tourniquets in the following indications: all single or multiple digital wounds, distal from the base of the proximal phalanx, irrespective of their nature and the suspected structural damage...
September 2016: Hand Surgery and Rehabilitation
Jeffrey E Keenan, Ehsan Benrashid, Emily Kale, Alina Nicoara, Aatif M Husain, G Chad Hughes
Circulatory management during replacement of the aortic arch is complex and involves a period of circulatory arrest to provide a bloodless field during arch vessel anastomosis. To guard against ischemic brain injury, tissue metabolic demand is reduced by systemically cooling the patient prior to circulatory arrest. Neurophysiological intraoperative monitoring (NIOM) is often used during the course of these procedures to provide contemporaneous assessment of brain status to help direct circulatory management decisions and detect brain ischemia...
October 4, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Levi Bassin, David Bell
The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable...
September 2016: Best Practice & Research. Clinical Anaesthesiology
Minja Milovanovic, Noah Taruberekera, Karin Hatzold, Neil Martinson, Limakatso Lebina
PrePex™ (Circ MedTech Ltd., Tortola, British Virgin Islands) devices are being evaluated in several countries for scale-up of medical male circumcision (MMC) as an HIV prevention intervention. Health care workers' perceptions should be considered prior to scale-up. A cross-sectional open-ended questionnaire was administered to health care workers from nine MMC programs in South Africa that provided either PrePex™ and surgical circumcision (mixed sites) or surgical circumcision only (surgery-only sites)...
November 2016: Journal of the Association of Nurses in AIDS Care: JANAC
Linda M S Resar, Elizabeth C Wick, Talal Nael Almasri, Elizabeth A Dackiw, Paul M Ness, Steven M Frank
BACKGROUND: Advances in our understanding of the risks associated with allogeneic blood transfusions (ABTs) and the growing number of patients who wish to avoid ABTs have led to the emergence of new treatment paradigms for "bloodless" medicine and surgery. STUDY DESIGN AND METHODS: Here, we review prior studies and summarize current strategies for bloodless care used at our institution. We advocate three basic principles: 1) diagnosing and aggressively treating anemia, 2) minimizing blood loss from laboratory testing and invasive procedures, and 3) identifying and managing bleeding diatheses...
October 2016: Transfusion
Gabriel Ferreira Nicoloso, Iuri Silveira dos Santos, Jorge Abel Flores, Bruno Lopes da Silveira, Marta Dutra Machado Oliveira
Ankyloglossia entails short lingual frenum, impairing satisfactory tongue movement and leading to problems related to deglutition, feeding and diction. This clinical report uses laser technology, rather than traditional surgical procedure with scalpel, to perform a lingual frenulotomy on a 9-year old child diagnosed with ankyloglossia, aiming to investigate more conservative and less traumatic dental procedures. Due to the many advantages of the laser device, such as bloodless surgical field, absence of sutures, minimal swelling and post-surgical pain, the high intensity diode laser is a viable alternative technique in soft tissue surgeries...
2016: Journal of Clinical Pediatric Dentistry
Suleiman Hussein Suleiman, El Sammani Wadaella, Ahmed Hassan Fahal
Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome...
June 2016: PLoS Neglected Tropical Diseases
Charles W Sauer, Krishelle L Marc-Aurele
BACKGROUND: Infants born at 23 weeks' gestation have a poor prognosis and require intensive care, including blood transfusions, to survive. Generally speaking, the decision to forgo life support is acceptable. Jehovah's Witnesses believe that life is sacred and want lifesaving interventions except for blood transfusions. Therefore, an ethical dilemma exists when a baby is born on the edge of viability to parents that are Jehovah's Witnesses. In this case, if parents and healthcare professionals disagree on the best interests of the child, the medical team should obtain a court order from the state to intervene...
2016: American Journal of Case Reports
Nathaniel J Jellinek, Nicole F Vélez
Nail surgery is a fundamental component of podiatric surgery. Nail disorders are common and may cause significant morbidity and occasionally mortality. Diagnosis of inflammatory and infectious conditions, and of benign or malignant tumors, often requires a biopsy of the nail unit. Excisional surgery may also be curative for certain tumors. This article reviews key elements of nail anatomy, surgical preparation, local anesthesia, and methods to achieve and maintain a bloodless field. A familiarity with these concepts should allow clinicians to develop a surgical plan and approach when patients present with a nail disorder requiring biopsy or surgical treatment...
July 2016: Clinics in Podiatric Medicine and Surgery
Robert A Sorabella, Laura Guglielmetti, Amanda Bader, Andres Gomez, Koji Takeda, Paul J Chai, Hiroo Takayama, Emile A Bacha, Yoshifumi Naka, Isaac George
BACKGROUND: Hypothermic circulatory arrest (HCA) has been used as an adjunct to cardiopulmonary bypass for decades, both electively and emergently, to facilitate a bloodless operative field while maintaining cerebral protection. The aim of this study is to determine the impact of HCA during heart transplantation on posttransplant outcomes. METHODS: All adult patients undergoing orthotopic heart transplantation at our institution between 2000 and 2012 were retrospectively reviewed...
October 2016: Annals of Thoracic Surgery
Oktay Irkorucu
BACKGROUND: Zuckerkandl tubercle (ZT) is a lateral projection from the lateral thyroid lobe which is a constant landmark for finding the recurrent laryngeal nerve during thyroid surgery. It is the condensed thyroid parenchyma located in the cricothyroid junction. Even today, ZT and its relationship with recurrent laryngeal nerve (RLN) is not well known by all surgeons. The objectives of the present study were to find out the incidence of ZT in our thyroidectomies and to investigate whether the ZT has a relationship with RLN...
May 2016: Annals of Medicine and Surgery
Marco Rispoli, Carlo Bergaminelli, Moana Rossella Nespoli, Mariana Esposito, Dario Maria Mattiacci, Antonio Corcione, Salvatore Buono
INTRODUCTION: A bloodless surgery can be desirable also for non Jehovah's witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning. PRESENTATION OF THE CASE: Our patient, a Jehovah's witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case. DISCUSSION: Before surgery a meticulous coagulopathy research and hemodynamic optimization are useful to prepare patient to operation...
2016: International Journal of Surgery Case Reports
Omar Tujjar, Angelo Raffaele De Gaudio, Lorenzo Tofani, Alessandro Di Filippo
Near-infrared spectroscopy (NIRS) has been used to detect in vivo microvascular alterations by means of a vascular occlusion test. We sought to analyse by NIRS the microcirculatory profile of patients undergoing prolonged tourniquet-induced bloodless condition for extremity surgery, and compare the results with time of ischemia and comorbidities. We conducted a prospective observational study on 42 patients undergoing upper limb surgery. Regional anaesthesia was achieved and ischemia was induced by a tourniquet cuffed at 250 mmHg...
April 12, 2016: Journal of Clinical Monitoring and Computing
D A Lees, J B Penny, P Baker
AIMS: The aim of this study was to compare the pain caused by the application of a tourniquet after exsanguination of the upper limb with that occurring after simple elevation. PATIENTS AND METHODS: We used 26 healthy volunteers (52 arms), each of whom acted as their own matched control. The primary outcome measure was the total pain experienced by each volunteer while the tourniquet was inflated for 20 minutes. This was calculated as the area under the pain curve for each individual subject...
April 2016: Bone & Joint Journal
F Alizadeh, A Fakoor, S Haghdani
OBJECTIVE: To compare tourniquet application and epinephrine injection for hemostasis during hypospadias surgery in terms of bleeding and complications. METHODS: Between April 2013 and September 2014, patients who were admitted for hypospadias repair were divided by random allocation into either a diluted epinephrine injection (DE) group or tourniquet application (T) group for hemostasis during the procedure. In the T group, a rubber band was applied at the base of the penis after skin dissection, and in the DE group, epinephrine 1/100,000 was injected along the incision lines...
June 2016: Journal of Pediatric Urology
Bahattin Tuncalı, Hakan Boya, Zeynep Kayhan, Şükrü Araç, M Ali Kolay Çamurdan
OBJECTIVE: The effectiveness of the arterial occlusion pressure (AOP) estimation method to set tourniquet inflation pressures was assessed in patients undergoing lower limb surgery. METHODS: One hundred ninety-eight operations were performed in 224 lower extremities of 193 patients. Tourniquet inflation pressures were set using the AOP estimation formula and adding 20 mmHg of safety margin to AOP value. Primary outcome measures were the amount of tourniquet pressure and its effectiveness...
2016: Acta Orthopaedica et Traumatologica Turcica
K Jolly, D Hammond, M Maher, D Evriviades
No abstract text is available yet for this article.
July 2016: British Journal of Oral & Maxillofacial Surgery
Rachel LaMonica, Judith Pinto, Danielle Luciano, Anya Lyapis, Anthony Luciano
STUDY OBJECTIVE: To compare the incidence of a uterine septum in women with and without endometriosis and if such incidence correlates with the stage of endometriosis Although a correlation between obstructive Mullerian anomalies and endometriosis has been well established, its link with non-obstructive anomalies remains controversial. To elucidate whether there is a correlation between endometriosis and non-obstructive Mullerian anomalies, we conducted this prospective study on all patients admitted to our Reproductive Endocrinology and Infertility surgical service from February 1, 2010 through June 30, 2012...
May 2016: Journal of Minimally Invasive Gynecology
Lin-Gwei Wei, Chieh-Feng Chen, Chun-Yuan Hwang, Chiung-Wen Chang, Wen-Kuan Chiu, Chun-Chang Li, Hsian-Jenn Wang
Tourniquets are often needed for optimized phalangeal surgeries. However, few surgeons forget to remove them and caused ischemic injuries. We have a modified method to create a safe finger tourniquet for short duration finger surgeries, which can avoid such tragedy. It is done by donning a glove, cutting the tip of the glove over the finger of interest, and rolling the glove finger to the base. From 2010 to 2013, approximately 54 patients underwent digital surgical procedures with our safe finger tourniquet...
March 2016: Annals of Plastic Surgery
Ayşın Ersoy, Mensure Çakırgöz, Zekeriya Ervatan, Özlem Kıran, Aygen Türkmen, Cem Zeki Esenyel
OBJECTIVE: Our study is a prospective, randomized study on patients undergoing arthroscopic shoulder surgery in the beach-chair position to evaluate the effects of positive end-expiratory pressure (PEEP) on hemodynamic stability, providing a bloodless surgical field and surgical satisfaction. METHODS: Fifty patients were divided into two groups. Group I (n=25) had zero end-expiratory pressure (ZEEP) administered under general anesthesia, and group II (n=25) had +5 PEEP administered...
2016: Acta Orthopaedica et Traumatologica Turcica
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