Blood Loss in pediatric spine surgery

Shapiro, Frederic; Sethna, Navil F.

doi:10.1007/3-540-27394-8_3

Cited by 40 publications

(74 citation statements)

References 64 publications

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“…All the other patients with normal preoperative echocardiography did not have any perioperative cardiac complications. Increased intraoperative blood loss is reported for patients with DMD [14,23,34,39]. Despite the fusion to the pelvis, our total blood loss of 3.7 l is well within other published data ranging from 3.1 to 4.9 l [12,22,28,38].…”

Section: Discussionsupporting

confidence: 86%

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

et al. 2007

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This report describes the spinal fixation with pedicle-screw-alone constructs for the posterior correction of scoliosis in patients suffering from Duchene muscular dystrophy (DMD). Twenty consecutive patients were prospectively followed up for an average of 5.2 years (min 2 years). All patients were instrumented from T3/T4 to the pelvis. Pelvic fixation was done with iliac screws similar to Galveston technique. The combination of L5 pedicle screws and iliac screws provided a stable caudal foundation. An average of 16 pedicle screws was used per patient. The mean total blood loss was 3.7 l, stay at the intensive care unit was 77 h and hospital stay was 19 days. Rigid stabilisation allowed immediate mobilisation of the patient in the wheel chair. Cobb angle improved 77% from 44°to 10°, pelvic tilt improved 65% from 14°to 3°. Lumbar lordosis improved significantly from 20°to 49°, thoracic kyphosis remained unchanged. No problems related to iliac fixation, no pseudarthrosis or implant failures were observed. The average percentage of predicted forced vital capacity (%FVC) of the patients was 55% (22-94%) preoperatively and decreased to 44% at the last follow-up. There were no pulmonary complications. One patient with a known cardiomyopathy died intraoperatively due to a sudden cardiac arrest. The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complications.

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Section: Discussionsupporting

confidence: 86%

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

et al. 2007

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“…Posterior spinal fusion surgery for adolescent idiopathic scoliosis is often associated with significant blood loss requiring transfusion due to prolonged operative times, extensive soft tissue dissection, and significant bone bleeding during instrumentation and decortications [1][2][3][4]. Allogenic blood transfusion has several inherent risks, including the transmission of blood-borne pathogens as well as hemolytic and immune-mediated transfusion reactions, such as graft versus host disease [5].…”

Section: Introductionmentioning

confidence: 99%

The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: A single-surgeon experience

Lykissas

Crawford

Chan

et al. 2013

Journal of Children's Orthopaedics

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Purpose Intraoperative blood loss in scoliosis surgery often requires transfusions. Autogenous blood decreases but does not eliminate risks typically associated with allogenic blood transfusion. Costs associated with transfusions are significant. Tranexamic acid (TXA) has been shown to decrease blood loss in cardiac and joint surgery. Few studies have examined its use in pediatric spine surgery, and the results are inconsistent. The aim of this study was to determine whether TXA decreases intraoperative blood loss and transfusion requirements in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by a single surgeon. Methods The medical records and operative reports of surgically treated patients with adolescent idiopathic scoliosis between 2000 and 2009 were retrospectively reviewed. The inclusion criteria were: (1) patients who underwent instrumented posterior spinal fusion, (2) had complete medical records, and (3) were treated by the same surgeon. Forty-nine patients who met the inclusion criteria were divided into two groups: Group A (25 patients) received TXA, while Group B (24 patients) did not receive TXA.Results After controlling for age at the time of surgery, gender, and number of vertebral levels fused, the mean intraoperative blood loss was significantly lower in Group A (537 ml) than in Group B (1,245 ml) (p = 0.027). The mean volume of blood transfused intraoperatively was 426 and 740 ml for Group A and Group B, respectively. The difference was not statistically significant after controlling for age, gender, and number of levels fused (p = 0.078). Conclusion TXA significantly decreased intraoperative blood loss in posterior spinal fusions performed for adolescent idiopathic scoliosis.

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“…1 Blood loss depends on the number of levels fused, duration of surgery, and physical status of the patient. Concerns regardingthe safety of transfused blood have led to the development ofa range of interventions to minimize blood loss during major surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…1 Allogeneic blood transfusion has several risks like transmission of blood-borne infections, haemolytic and immune-mediated transfusion reactions. 2 Perioperative bleeding during spine surgery obscures the surgical field and enhances the risk of epidural haematoma, which may result in cord compression.…”

Section: Introductionmentioning

confidence: 99%

A randomized prospective study of efficacy of Tranexamic Acid on Perioperative Blood Loss in Thoracic Spine Fixation

Basavaraj¹,

Hegde²

2017

Sri Lankan J Anaesthesiol

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Background: Spine surgery is associated with significant blood loss, often requiring blood transfusion. The objective of this double blind study was to evaluate the efficacy of tranexamic acid (TXA) on perioperative blood loss in patients undergoing thoracic spine fixation. Materials and Methods:Sixty adult patients were randomized into two groups of 30 each. Group I received a bolus of 15 mg/kg i.v. of TXA after induction followed by a maintenance infusion of 1 mg/kg/hr up to closure of skin and Group II received an equivalent volume of normal saline after induction followed by a maintenance infusion of saline up to closure of skin. Outcome measures included perioperative blood loss, amount of blood transfusion, postoperative haemoglobin and haematocrit levels. Results:The mean perioperative blood loss was less in the TXA group compared to the placebo group (p value<0.001). The PRBCs transfusion was lower in the TXA group compared to the placebo group but there was no statistically significant difference between the two groups. The postoperative haemoglobin level was lower in the control group as compared to TXA group (p value <0.05). Conclusion:TXA is effective in reducing peri-operative blood loss and blood transfusion.

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Blood Loss in pediatric spine surgery

Cited by 40 publications

References 64 publications

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: A single-surgeon experience

A randomized prospective study of efficacy of Tranexamic Acid on Perioperative Blood Loss in Thoracic Spine Fixation

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