The Effect of Amicar on Perioperative Blood Loss in Idiopathic Scoliosis:

Florentino-Pineda, Ivan; Thompson, George H.; Poe-Kochert, Connie; Huang, Robert P.; Haber, Lawrence; Blakemore, Laurel C.

doi:10.1097/01.brs.0000109883.18015.b9

Cited by 135 publications

(42 citation statements)

References 19 publications

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“…By local cooling hematoma formation can be reduced by decreasing RBBF. In clinical practice, bleeding control of cancellous bone can only be achieved by application of bone wax, Gelfoam paste, Amicar, and therapeutic angiography . In this regard, local cooling would be a sufficient method to reduce bone bleeding reliably by decreasing bone blood flow after surgery—so far ice application is mainly performed to decrease pain, but not to affect blood flow.…”

Section: Discussionmentioning

confidence: 99%

Local cooling reduces regional bone blood flow

Venjakob

Vogt

Stöckl

et al. 2013

Journal Orthopaedic Research

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Local cooling is very common after bone and joint surgery. Therefore the knowledge of bone blood flow during local cooling is of substantial interest. Previous studies revealed that hypothermia leads to vasoconstriction followed by decreased blood flow levels. The aim of this study was to characterize if local cooling is capable of inducing reduced blood flow in bone tissue using a stepwisereduced temperature protocol in experimental rabbits. To examine bone blood flow we utilized the fluorescent microsphere (FM) method. In New Zealand white rabbits one randomly chosen hind limb was cooled stepwise from 32 to 2˚C, whereas the contra lateral hind limb served as control. Injection of microspheres was performed after stabilization of bone and muscle temperature at each temperature level. Bones were removed, dissected and fluorescence intensity was determined to calculate blood flow values. We found that blood flow of all cooled regions decreased relative to the applied external temperature. At maximum cooling blood flow was almost completely disrupted, indicating local cooling as powerful regulatory mechanism for regional bone blood flow (RBBF). Postoperative cooling therefore may lead to strongly decreased bone blood flow values. As a result external cooling has capacity to both diminish bone healing and reduce bleeding complications. ß

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Section: Discussionmentioning

confidence: 99%

Local cooling reduces regional bone blood flow

Venjakob

Vogt

Stöckl

et al. 2013

Journal Orthopaedic Research

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“…We did not analyze the factors contributing to intraoperative blood loss, and this could be a limitation of this study. Considering that intraoperative blood loss is an important factor effecting postoperative blood loss, the use of antifibrinolytic or hemostatic agents proven to be effective in reducing postoperative blood loss [18-20] may be useful in case of heavy bleeding during the surgery.…”

Section: Discussionmentioning

confidence: 99%

The effect of postoperative pain on postoperative blood loss after sequential bilateral total knee arthroplasty

Kim

et al. 2011

Korean J Anesthesiol

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BackgroundBilateral total knee arthroplasty is generally accompanied by a significant amount of blood loss. We investigated the relationship between the intensity of pain and the amount of blood loss in the early postoperative period after bilateral total knee arthroplasty.MethodsA prospective study was conducted on 91 patients who underwent elective sequential bilateral total knee arthroplasty for osteoarthritis. All patients received combined spinal and epidural anesthesia. Patients were divided into three groups based on their scores on the verbal numerical rating scale (VNRS) for pain at 6 hours postoperatively. The VNRS was classified as follows; mild pain (n = 34, VNRS score 0-4), moderate pain (n = 24, VNRS score 5-6), and severe pain (n = 33, VNRS score 7-10). We compared the mean arterial pressures and the amount of blood loss during the first 24 postoperative hours in the three groups. Factors influencing postoperative blood loss were analyzed.ResultsPostoperative mean arterial pressures and blood loss were not different among the groups. Of the factors examined, the amount of postoperative blood loss was only dependent on the amount of intraoperative blood loss (P = 0.001).ConclusionsEarly postoperative pain has no effect on postoperative blood pressure and the amount of blood loss after bilateral total knee arthroplasty. For postoperative blood loss, intraoperative blood loss is the main determinant.

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“…(7–10) In addition, several of these studies have significant limitations that may jeopardize the validity of their results. For example, of the three randomized trials that have evaluated the effect of EACA on RBC transfusion requirements in patients undergoing spinal surgery (7–9), one evaluated pediatric scoliosis patients and concluded that EACA was an effective method to significantly reduce perioperative blood loss and autologous transfusion requirements, however none of these patients received an allogeneic transfusion. (9) Two studies (7–8) concluded that EACA did not reduce transfusion exposure; however these studies included fewer patients than our study.…”

Section: Discussionmentioning

confidence: 99%

“…For example, of the three randomized trials that have evaluated the effect of EACA on RBC transfusion requirements in patients undergoing spinal surgery (7–9), one evaluated pediatric scoliosis patients and concluded that EACA was an effective method to significantly reduce perioperative blood loss and autologous transfusion requirements, however none of these patients received an allogeneic transfusion. (9) Two studies (7–8) concluded that EACA did not reduce transfusion exposure; however these studies included fewer patients than our study. The remaining study (10) used a historical control and the observed benefit of EACA may have been due to improvements in surgical treatment, patient selection, or changes in criteria for transfusion between the treatment periods.…”

Section: Discussionmentioning

confidence: 99%

Effect of Epsilon Aminocaproic Acid on Red-Cell Transfusion Requirements in Major Spinal Surgery

Berenholtz¹,

Pham²,

Garrett‐Mayer³

et al. 2009

Spine

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Study Design Randomized, placebo-controlled trial Objective To evaluate the efficacy of epsilon aminocaproic acid (EACA) to reduce the number of red-cell (RBC) transfusions in adult patients undergoing major spinal surgery. Summary of Background Data Reconstructive spinal surgery is associated with significant blood loss. The number of studies evaluating the efficacy of EACA in adult patients undergoing spinal surgery remains scarce and limited. Methods EACA (100 mg/kg) or placebo was administered to 182 adult patients after the induction of anesthesia followed by an infusion that was continued for 8 hours postoperatively. Primary end-points included total allogeneic RBC transfusions through postoperative day (POD) 8 and postoperative allogeneic plus autologus RBC transfusions through POD 8. Results Mean total allogeneic RBC transfusions were not statistically different between the groups (5.9 units EACA versus 6.9 units placebo; P=0.17). Mean postoperative RBC transfusions in the EACA group was less (2.0 units versus 2.8 units placebo; P=0.03). There was no significant difference in mean estimated intraoperative EBL (2938 cc EACA vs. 3273 cc placebo; P=0.32). Mean intensive care unit length of stay was decreased (EACA 1.8 days versus 2.8 days placebo; P=0.04). The incidence of thromboembolic complications was similar (2.2% EACA vs 6.6% placebo; P=0.15). Conclusions The difference in total allogeneic RBC transfusions between the groups was not statistically significant. EACA was associated with a 30% (0.8 units) reduction in postoperative RBC transfusions and a one-day reduction in ICU LOS, without an increased incidence of thromboembolic events. EACA may be considered for patients undergoing major spinal surgery. Larger studies are needed to evaluate the relationship between EACA and total RBC requirements.

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The Effect of Amicar on Perioperative Blood Loss in Idiopathic Scoliosis:

Cited by 135 publications

References 19 publications

Local cooling reduces regional bone blood flow

Local cooling reduces regional bone blood flow

The effect of postoperative pain on postoperative blood loss after sequential bilateral total knee arthroplasty

Effect of Epsilon Aminocaproic Acid on Red-Cell Transfusion Requirements in Major Spinal Surgery

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