BACKGROUNDPostoperative blood loss remains a major concern in cardiac surgeries. At least 30% of the times, the cause for blood loss is attributed to diffuse microvascular bleeding. [1] It results from a multifactorial coagulopathy in which the predominant factors are thrombocytopenia, acquired platelet dysfunction, loss of clotting factors, unneutralised heparin and increased fibrinolysis. Objective-Postoperative blood loss remains a major concern in cardiac surgeries, where microvascular bleeding is an important factor due to various reasons including the use of cardiopulmonary bypass pump [CPB]. Tranexamic acid [TA] is extensively being used in major surgeries to reduce perioperative blood loss. Topical application may reduce the incidence of thrombotic complications in coronary artery bypass surgeries [CABG] as compared to its parenteral supplementation as well as effective in reducing postoperative blood loss.
MATERIALS AND METHODSThis was a prospective, randomised, double-blinded study. Randomisation was done taking lots, where both the Surgeon and the Anaesthesiologist were blinded to drug being used. A total of 60 patients, wherein half the number of patients were allocated to receive the TA 2 gm diluted in 200 mL normal saline topically as compared to the other half receiving only normal saline. The postoperative bleeding was analysed at 2, 8 and 24 hours.
RESULTSThere was mild reduction in the amount of blood loss in the TA group during all the periods, 112 mL v/s 125 mL at 2 hours, 343 mL v/s 391 mL at 8 hours and 541 mL v/s 639 mL at 24 hours.
CONCLUSIONIn our study, we observed lesser drainage in TA group consistently till 24 hours postoperatively, but without achieving statistical significance.
Hydatid cyst infestation is most commonly encountered in liver. Though several procedures have been described in the treatment of hepatic echinococcal cysts ranging from simple puncture to liver resection, radical surgery (Total pericystectomy or partial hepatectomy) is indicated for liver cyst. Prevention of spillage into the peritoneal cavity and wound edges by injecting a scolicidal agent into the unopened cyst and walling off the operative field with sponges soaked in a scolicidal agent are the two most commonly employed measures. 20% hypertonic saline is one of the recommended scolicidal agent, but can be associated with hypernatremia. Anaphylaxis during hydatid cyst resection is one of the rare occurrences. We hereby describe the twin problem of Anaphylaxis intraoperatively and hypernatremia postoperatively and its management.
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