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Intraoperative hemorrhage is an important factor affecting intraoperative safety and postoperative patient recovery in percutaneous nephrolithotomy (PCNL). This study aimed to identify the factors that influence intraoperative hemorrhage during PCNL and develop a predictive nomogram model based on these factors.A total of 118 patients who underwent PCNL at the Department of Urology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from January 2021 to September 2023 was included in this study. The patients were divided into a hemorrhage group (58 cases) and a control group (60 cases) based on the decrease in hemoglobin levels after surgery. The clinical data of all patients were collected, and both univariate analysis and multivariate logistic regression analysis were conducted to identify the independent risk factors for intraoperative hemorrhage during PCNL. The independent risk factors were used to construct a nomogram model using R software. Additionally, receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were utilized to evaluate the model.Multivariate logistic regression analysis revealed that diabetes, long operation time and low psoas muscle mass index (PMI) were independent risk factors for intraoperative hemorrhage during PCNL (P < 0.05). A nomogram model was developed incorporating these factors, and the areas under the ROC curve (AUCs) in the training set and validation set were 0.740 (95% CI: 0.637–0.843) and 0.742 (95% CI: 0.554–0.931), respectively. The calibration curve and Hosmer-Lemeshow test (P = 0.719) of the model proved that the model was well fitted and calibrated. The results of the DCA showed that the model had high value for clinical application.Diabetes, long operation time and low PMI were found to be independent risk factors for intraoperative hemorrhage during PCNL. The nomogram model based on these factors can be used to predict the risk of intraoperative hemorrhage, which is beneficial for perioperative intervention in high-risk groups to improve the safety of surgery and reduce the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Intra-operative bleeding during CS due to placenta accreta spectrum (PAS) disorders is a major cause of maternal mortality and morbidity. Moreover, a well-planned cesarean section (CS), presence of expert team and preoperative preparation of blood and blood elements decreases blood loss and, consequently, maternal morbidity and mortality. So, we found it important to predict blood loss during CS for PAS using ultrasound that has high accuracy in visualization of placental and subplacental vascularity. So we aimed to evaluate the benefit of ultrasound in predicting intraoperative blood loss during planned cesarian sections in cases of PAS. Methods: This prospective observational study was carried out on 98 pregnant women with placenta previa who had a history of one or repeated CSs and were suspected of having an abnormally invasive placenta in the Obstetrics and Gynecology Department at the Emergency Unit in Zagazig University Hospital. A sonogram was performed, and the amount of blood loss was calculated. Results: Regarding prediction of major hemorrhage, sub-placental hypervascularity and intra-placental hypervascularity showed the highest sensitivity (91.7%) and negative predictive value (93.8% and 90.9%, respectively). Lacunae at the placental-serosal interface showed the highest specificity (91.9%), positive predictive value (40%), and accuracy (73.5%). On multivariate regression analysis, the presence of more than 4 placental lacunae independently increased the risk of major hemorrhage by 3.7 times, while sub-placental hypervascularity independently increased the risk by 5.3 times. Conclusions: Color Doppler ultrasound study of placental and sub-placental vascularity can predict major intraoperative hemorrhage in cases of placenta accreta spectrum. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of intravenous tranexamic acid administered prior to external dacryocystorhinostomy (DCR) surgery to decrease intraoperative bleeding under general anesthesia. Methods: This was a double-blinded randomized placebo-controlled trial. A total of 70 patients (35 intervention and 35 control) with nasolacrimal duct obstruction (NLDO) who were selected for DCR surgery between September 2021 and September 2022 were included. After clinical examinations and laboratory tests, patients were randomly classified into intervention and control groups. The intervention group received 10 mg/kg intravenous tranexamic acid to a maximum dose of 1 gr 30 minutes before the surgery. Controls received normal saline solution as a placebo. The amount of intraoperative bleeding and surgical time were compared between the two groups. Results: The intervention group included 21 men (60%) and 14 women (40%), while the control group included 19 men (54.3%) and 16 women (45.7%). The mean ages of the participants were 55.46 ±10.8 years and 58.06 ±11.28 years in the intervention and control groups, respectively. A significant difference was observed between the two groups in the surgical time analysis (control group: 37.74 ±9.52 minutes vs intervention: 26.03 ±10.5 minutes; P <0.001). Additionally, there was a significant difference in the bleeding volume between the intervention (70.66 ±48.19 ml) and control (47.74 ±60 ml) groups (P <0.001). Conclusion: Intravenous tranexamic acid administration before the DCR procedure can successfully control bleeding during the surgery. [ABSTRACT FROM AUTHOR]

Background: Endoscopic transnasal optic canal decompression is widely used in the treatment of traumatic optic neuropathy (TON) following head and craniofacial trauma. Intraoperative hemorrhage is a catastrophic surgical complication during optic canal decompression. Case description: We present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery. Conclusion: The intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization. [ABSTRACT FROM AUTHOR]

This study aims to assess the differences in coagulation function, intraoperative bleeding and hemostasis time resulting from immediate versus delayed infusion of residual physical blood in patients undergoing cardiopulmonary bypass for aortic dissection. From January 2018 to January 2021, the data of 122 patients diagnosed with acute Stanford type A aortic dissection and treated at Taihe Hospital Affiliated Hospital of Hubei University of Medicine were retrieved and assessed. They were then divided into two groups according to different treatments: a research group and a control group. The research group received a delayed infusion of residual physical blood intraoperatively, while the control group underwent immediate infusion. Various indicators of coagulation, encompassing activated partial thromboplastin time, prothrombin time, thrombin time, and fibrinogen levels, along with hemoglobin levels, utilization of blood products such as red cell suspension, plasma, platelets, and cryoprecipitate, as well as the volume of bleeding, total fluid intake and output, and durations of hemostasis, surgery, and anesthesia, were compared between the two groups. After surgery, coagulation and hemoglobin levels, which were initially similar between the two groups, were found to be significantly improved, with the research group showing superior outcomes (p < 0.05). Additionally, patients in the research group required significantly fewer blood products, experienced reduced bleeding and total body fluid exchange and had markedly shorter durations of hemostasis, surgery and anesthesia compared to those in the control group (p < 0.05). Pre-infusion adjustment of coagulation function before residual whole blood infusion effectively improves coagulation, reduces bleeding and fluid imbalance, and shortens hemostasis time during aortic dissection surgery with cardiopulmonary bypass. This approach not only reduces transfusion-related risks and improves postoperative recovery but also plays a significant role in optimizing blood management. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Following the reintroduction of aprotinin into the European market, the French Society of Cardiovascular and Thoracic Anaesthesiologists recommended its prophylactic use at half-dose for high-risk cardiac surgery patients. We examined whether the use of aprotinin instead of tranexamic acid could significantly reduce severe perioperative bleeding. METHODS This multicentre, retrospective, historical study included cardiac surgery patients treated with aprotinin or tranexamic acid between December 2017 and September 2020. The primary efficacy end point was the severe or massive perioperative bleeding (class 3–4 of the universal definition of perioperative bleeding). The safety secondary end points included the occurrence of thromboembolic events and all-cause mortality within 30 days after surgery. RESULTS Among the 693 patients included in the study, 347 received aprotinin and 346 took tranexamic acid. The percentage of patients with severe or massive bleeding was similar in the 2 groups (42.1% vs 43.6%, Adjusted odds ratio [ORadj] = 0.87, 95% confidence interval: 0.62–1.23, P  =   0.44), as was the perioperative need for blood products (81.0% vs 83.2%, ORadj = 0.75, 95% confidence interval: 0.48–1.17, P  =   0.20). However, the median (Interquartile range) 12 h postoperative blood loss was significantly lower in the aprotinin group (383 ml [241–625] vs 450 ml [290–730], P  <   0.01). Compared to tranexamic acid, the intraoperative use of aprotinin was associated with increased risk for thromboembolic events (adjusted Hazard ratio 2.30 [95% Cl: 1.06–5.30]; P  = 0.04). CONCLUSIONS Given the modest reduction in blood loss at the expense of a significant increase in thromboembolic adverse events, aprotinin use in high-risk cardiac surgery patients should be based on a carefully considered benefit–risk assessment. [ABSTRACT FROM AUTHOR]

Background Textbook outcome is a valuable tool for assessing surgical outcomes. The aim of this study was to analyse textbook-outcome rates in the prospective Spanish National Registry of the Liver-First Approach (RENACI Project) and the factors influencing textbook-outcome achievement. Additionally, a model for assessing a procedure-specific textbook outcome for the liver-first approach was proposed. Methods A retrospective analysis of a prospective and multicentre database that included consecutive patients with colorectal cancers and synchronous liver metastases who underwent a liver-first approach between June 2019 and August 2020 was performed. Two types of textbook outcome were measured: classic textbook outcome and liver-first-approach-specific textbook outcome (which included negative margins, no perioperative transfusion, no postoperative major surgical complications, no prolonged length of hospital stay, no readmissions, no mortality, and full treatment completion). The primary endpoint was textbook-outcome rate for a liver-first approach at 90 days. Results A total of 149 patients were included in the analysis. Classic and liver-first-approach-specific textbook-outcome rates were 71.8 per cent (107 patients) and 46 per cent (69 patients) respectively. Factors significantly associated with liver-first-approach-specific textbook-outcome achievement in the multivariable analysis were the number of metastases (OR 0.82 (95 per cent c.i. 0.73 to 0.92); P = 0.001) and intraoperative blood loss (OR 0.99 (95 per cent c.i. 0.99 to 1.00); P = 0.007). Prolonged length of hospital stay (33 patients, 41 per cent), positive margins (31 patients, 39 per cent), perioperative transfusion (27 patients, 34 per cent), and no full treatment completion (18 patients, 23 per cent) were the items that most frequently prevented liver-first-approach-specific textbook-outcome achievement. Conclusion Liver-first-approach-specific textbook outcome is a promising tool for measuring the quality of care when using the liver-first approach for synchronous colorectal liver metastases. [ABSTRACT FROM AUTHOR]

Abstract Background Prediction tools for various intraoperative bleeding events remain scarce. We aim to develop machine learning-based models and identify the most important predictors by real-world data from electronic medical records (EMRs). Methods An established database of surgical inpatients in Shanghai was utilized for analysis. A total of 51,173 inpatients were assessed for eligibility. 48,543 inpatients were obtained in the dataset and patients were divided into haemorrhage (N = 9728) and without-haemorrhage (N = 38,815) groups according to their bleeding during the procedure. Candidate predictors were selected from 27 variables, including sex (N = 48,543), age (N = 48,543), BMI (N = 48,543), renal disease (N = 26), heart disease (N = 1309), hypertension (N = 9579), diabetes (N = 4165), coagulopathy (N = 47), and other features. The models were constructed by 7 machine learning algorithms, i.e., light gradient boosting (LGB), extreme gradient boosting (XGB), cathepsin B (CatB), Ada-boosting of decision tree (AdaB), logistic regression (LR), long short-term memory (LSTM), and multilayer perception (MLP). An area under the receiver operating characteristic curve (AUC) was used to evaluate the model performance. Results The mean age of the inpatients was 53 ± 17 years, and 57.5% were male. LGB showed the best predictive performance for intraoperative bleeding combining multiple indicators (AUC = 0.933, sensitivity = 0.87, specificity = 0.85, accuracy = 0.87) compared with XGB, CatB, AdaB, LR, MLP and LSTM. The three most important predictors identified by LGB were operative time, D-dimer (DD), and age. Conclusions We proposed LGB as the best Gradient Boosting Decision Tree (GBDT) algorithm for the evaluation of intraoperative bleeding. It is considered a simple and useful tool for predicting intraoperative bleeding in clinical settings. Operative time, DD, and age should receive attention.

Abstract Purpose: To investigate the effect of intravenous tranexamic acid administered prior to external dacryocystorhinostomy (DCR) surgery to decrease intraoperative bleeding under general anesthesia. Methods: This was a double-blinded randomized placebo-controlled trial. A total of 70 patients (35 intervention and 35 control) with nasolacrimal duct obstruction (NLDO) who were selected for DCR surgery between September 2021 and September 2022 were included. After clinical examinations and laboratory tests, patients were randomly classified into intervention and control groups. The intervention group received 10 mg/kg intravenous tranexamic acid to a maximum dose of 1 gr 30 minutes before the surgery. Controls received normal saline solution as a placebo. The amount of intraoperative bleeding and surgical time were compared between the two groups. Results: The intervention group included 21 men (60%) and 14 women (40%), while the control group included 19 men (54.3%) and 16 women (45.7%). The mean ages of the participants were 55.46 ± 10.8 years and 58.06 ± 11.28 years in the intervention and control groups, respectively. A significant difference was observed between the two groups in the surgical time analysis (control group: 37.74 ± 9.52 minutes vs intervention: 26.03 ± 10.5 minutes; P < 0.001). Additionally, there was a significant difference in the bleeding volume between the intervention (70.66 ± 48.19 ml) and control (47.74 ± 60 ml) groups (P < 0.001). Conclusion: Intravenous tranexamic acid administration before the DCR procedure can successfully control bleeding during the surgery.

Juvenile nasopharyngeal angiofibroma (JNA) is a very rare hemorrhagic vascular tumor that predominantly affects adolescent boys. The tumor is relatively large when detected, and the risk of intraoperative bleeding is high. We aimed to examine factors associated with intraoperative blood loss in JNA surgery. Thirteen patients with JNA who underwent surgery at the Jikei University Hospital between 2009 and 2020 were retrospectively reviewed, and factors associated with blood loss were examined by single regression analysis. The mean age was 20.8 ± 7.7 years. Preoperative angiographic images were evaluated in 9 of the 13 cases. The 6 patients with the largest bleeding volumes, all had residual nutrient vessels from the internal carotid artery (ICA), with an average number of 2.5 vessels. The mean blood loss of patients with residual nutrient vessels from the ICA was 3037 ± 2568 mL. Single regression analysis of bleeding volume against the number of remaining nutrient vessels from the ICA and the total peak contrast density of nutrient vessels (C max) standardized by region of interest showed that the coefficient was positive (P < 0.05 for both), confirming a significant correlation between the 2, respectively. The amount of bleeding significantly correlated with the number of remaining nutrient vessels from the ICA after preoperative embolization and with the total C max /region of interest. The ability to predict the amount of preoperative blood loss using this study will facilitate proposals for external incisions in patients with JNA. [ABSTRACT FROM AUTHOR]

Background: Prediction tools for various intraoperative bleeding events remain scarce. We aim to develop machine learning-based models and identify the most important predictors by real-world data from electronic medical records (EMRs). Methods: An established database of surgical inpatients in Shanghai was utilized for analysis. A total of 51,173 inpatients were assessed for eligibility. 48,543 inpatients were obtained in the dataset and patients were divided into haemorrhage (N = 9728) and without-haemorrhage (N = 38,815) groups according to their bleeding during the procedure. Candidate predictors were selected from 27 variables, including sex (N = 48,543), age (N = 48,543), BMI (N = 48,543), renal disease (N = 26), heart disease (N = 1309), hypertension (N = 9579), diabetes (N = 4165), coagulopathy (N = 47), and other features. The models were constructed by 7 machine learning algorithms, i.e., light gradient boosting (LGB), extreme gradient boosting (XGB), cathepsin B (CatB), Ada-boosting of decision tree (AdaB), logistic regression (LR), long short-term memory (LSTM), and multilayer perception (MLP). An area under the receiver operating characteristic curve (AUC) was used to evaluate the model performance. Results: The mean age of the inpatients was 53 ± 17 years, and 57.5% were male. LGB showed the best predictive performance for intraoperative bleeding combining multiple indicators (AUC = 0.933, sensitivity = 0.87, specificity = 0.85, accuracy = 0.87) compared with XGB, CatB, AdaB, LR, MLP and LSTM. The three most important predictors identified by LGB were operative time, D-dimer (DD), and age. Conclusions: We proposed LGB as the best Gradient Boosting Decision Tree (GBDT) algorithm for the evaluation of intraoperative bleeding. It is considered a simple and useful tool for predicting intraoperative bleeding in clinical settings. Operative time, DD, and age should receive attention. [ABSTRACT FROM AUTHOR]

Nationwide databases show that iatrogenic stroke and postoperative hematoma are among the commonest complications in brain tumor surgery, with a 10-year incidence of 16.3/1000 and 10.3/1000, respectively. However, techniques for handling severe intraoperative hemorrhage and dissecting, preserving, or selectively obliterating vessels traversing the tumor are sparse in the literature. Records of the senior author's intraoperative techniques during severe haemorrhage and vessel preservation were reviewed and analyzed. Intraoperative media demonstrations of key techniques were collected and edited. In parallel, a literature search investigating technique description in handling severe intraoperative hemorrhage and vessel preservation in tumor surgery was undertaken. Histologic, anesthetic, and pharmacologic prerequisites of significant hemorrhagic complications and hemostasis were analyzed. The senior author's techniques for arterial and venous skeletonization, temporary clipping with cognitive or motor mapping, and ION monitoring were categorized. Vessels interfacing with tumor are labeled intraoperatively as supplying/draining the tumor, or traversing en passant, while supplying/draining functional neural tissue. Intraoperative techniques of differentiation were analyzed and illustrated. Literature search found 2 vascular-related complication domains in tumor surgery: perioperative management of excessively vascular intraparenchymal tumors and lack of intraoperative techniques and decision processes for dissecting and preserving vessels interfacing or traversing tumors. Literature searches showed a dearth of complication-avoidance techniques in tumor-related iatrogenic stroke, despite its high prevalence. A detailed preoperative and intraoperative decision process was provided along with a series of case illustrations and intraoperative videos showing the techniques required to reduce intraoperative stroke and associated morbidity addressing a void in complication avoidance of tumor surgery. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy of different methods of osteotomy in the treatment of severe Winter type I adolescent congenital kyphoscoliosis (CKS) and to analyze the influencing factors of massive intraoperative hemorrhage in these patients., Methods: A retrospective analysis was conducted on the clinical data of 47 patients with severe CKS admitted to our hospital from October 2016 to December 2022. According to different surgical methods, they were divided into a PSO group and a VCR group. All patients in the PSO group were treated with multi-segment pedicle subtraction osteotomy (PSO), n=24. All patients in the VCR group were treated with single-segment vertebral column resection (VCR), n=23. The surgical status (including operation time, intraoperative blood loss, and days of hospitalization), surgical correction situation (including coronal Cobb angle, global kyphosis (GK), visual analogue scale (VAS) score, and Oswestry disability index (ODI)), and the occurrence of complications were analyzed and compared between the two groups of patients. The occurrence of massive intraoperative bleeding in patients was assessed, and a multivariate Logistic analysis was performed to identify the independent influencing factors of massive intraoperative hemorrhage in all patients., Results: The operation time of the PSO group was longer than that of the VCR group (P<0.05). No statistical differences were found in the comparison of coronal Cobb angle, GK, VAS score and ODI score between the PSO group and the VCR group before surgery (all P>0.05). After surgery, the coronal Cobb angle, GK, VAS score, and ODI score of patients in both groups were significantly improved compared with those before surgery (all P<0.05). Moreover, the improvements in coronal Cobb angle, GK and ODI score in the PSO group were more significant than those in the VCR group (all P<0.05). All patients were followed up for more than 18 months. During the follow-up period, the incidence of complications in the VCR group was higher than that in the PSO group, but with no statistically significant difference (P>0.05). According to the occurrence of massive intraoperative hemorrhage, the patients were divided into a hemorrhage group (n=19) and a normal group (n=28). Univariate analysis showed that there were statistically significant differences in the number of fixed segments, the osteotomy site, ESR, coronal Cobb angle, GK and the number of osteotomy segments between the hemorrhage group and the normal group (all P<0.05). The results of multivariate logistic regression analysis showed that the number of fixed segments, osteotomy site, coronal Cobb angle, and the number of osteotomy segments were independent influencing factors for massive intraoperative hemorrhage in patients with CKS., Conclusion: Both multi-segment PSO and VCR have good correction outcomes on CKS. In comparison, although multi-segment PSO has a longer operation time, its correction outcomes are better than that of VCR, and it does not significantly increase the risk of surgical complications. In addition, the number of fixed segments, osteotomy site, coronal Cobb angle, and the number of osteotomy segments are independent influencing factors for massive intraoperative hemorrhage., Competing Interests: None., (AJTR Copyright © 2025.)

This clinical trial discusses the efficacy of premedication with desmopressin in the management of bleeding and clears the surgical field during rhinoplasty surgery. This study is a randomized, double-blinded placebo-control clinical trial. Seventy patients were enrolled in this study and divided into two equal intervention-control groups. Thirty minutes before surgery, the intervention group received 500 ml of normal saline containing 0.1 μg/kg desmopressin and, the control group received 500 ml of normal saline. According to the surgeon's opinion, the local distribution of bleeding was dramatically different in both groups. While DDAVP receivers had grade 1 or 2 bleeding (according to the FROMME-BOEZAART grading score), the control group had grade 3 or 4 bleeding, and this difference was statistically meaningful. It seems that intravenous DDAVP can reduce bleeding and clear the surgical field during rhinoplasty surgery, but further studies are needed to determine the exact role and dose of the DDAVP. [ABSTRACT FROM AUTHOR]

Background: Transurethral resection of the prostate (TURP) is the gold standard for benign prostatic enlargement; however, hemorrhage still remains one of the major complications. Objective: The primary aim of this study was to evaluate the effect of tranexamic acid (TXA) in reducing intraoperative blood loss and need for blood transfusion. Secondary parameters compared were operating time, volume of irrigation fluid used, and reduction in hemoglobin concentration. Subjects and Methods: A total of 70 eligible patients undergoing TURP were randomized based on computer generated table into two groups. The study group (1) received IV TXA 500 mg after induction of anesthesia and 500 mg in each irrigation fluid bottle (dual mode) and the control group (2) received none. Results: The mean age (68.20 vs. 66.5 years), prostate size (57 vs. 51 g), and preoperative hemoglobin (13.3 vs. 13.5 g/dl) were similar between the groups. Intraoperative blood loss in the TXA group was found to be significantly reduced (174.60 ± 125.38 ml vs. 232.47 ± 116.8; P = 0.04). Blood transfusion was required in 2.8% of cases as compared to 14.2% in controls. Operating time, volume of irrigation fluid, and postoperative reduction of hemoglobin were not significant between the groups. No complications were observed in both groups. Conclusion: In this study, we observed that TXA, when used as a combination of Intravenous and topical route, effectively reduced intra-operative blood loss and the need for transfusion.

Temporary vessel occlusion enables a surgeon dissect aneurysm and clip with a lower risk of intraoperative hemorrhage with the associated risk of ischemia. There are studies on permissible time of occlusion of the parent artery using temporary clip; however, the actual incidence of silent ischemic events in patients with aneurysms treated with microsurgical clipping is not well documented. We are trying to look for the association between temporary clipping and incidence of ischemia through this study. The study concluded the statistically significant association between the maximum time of single clip application and ischemia. Intermittent multiple temporary clippings can prevent ischemia instead of a single clipping of longer duration.

Objective: To analyze the correlation between intraoperative hemorrhage and anesthesia factors during the repeat cesarean section to provide research basis for optimizing anesthesia management program. Methods: A total of 1192 parturient women, who underwent caesarean section again, were selected and divided into study group (the amount of intraoperative hemorrhage≥ 500 mL) and control group (the amount of intraoperative hemorrhage <500 mL) according to the amount of intraoperative hemorrhage. The general factors and anesthesia factors related to intraoperative hemorrhage between the two groups of parturient women were compared and analyzed. Results: The amount of intraoperative hemorrhage of 106 cases ≥500 mL, the incidence was 8.89%. The proportion of abortion history, the proportion of prenatal anemia, the proportion of placenta previa, the proportion of placenta adhesion, the proportion of placenta implantation, the proportion of uterine atony of the parturient women in the study group were higher than those in the control group, and the pregnancy process was shorter than that in the control group, the differences were statistically significant (P<0.05). The time of operation, the proportion of hysterectomy or partial hysterectomy, the proportion of ASA Ⅱ ~ Ⅲ grade and the proportion of ropivacaine dosage > 15 mg of the parturient women in the study group were significantly higher than those in the control group, the differences were statistically significant (P<0.05). The results of logistic multiple regression analysis showed that the occurrence of intraoperative hemorrhage during the repeat cesarean section was correlated with placenta previa, placenta implantation, uterine atony, hysterectomy or partial resection and ASA grade (P<0.05). Conclusion: The risk of intraoperative hemorrhage during the repeat cesarean section is not only related to placental and uterine factors, but also affected by operation and anesthesia factors. The clinician should make a comprehensive and accurate preoperative evaluation on the parturient women, optimize anesthesia management plan and operation strategy, so as to reduce the occurrence of intraoperative hemorrhage and ensure the safety of operation. [ABSTRACT FROM AUTHOR]

Background: Transurethral resection of the prostate (TURP) is the gold standard for benign prostatic enlargement; however, hemorrhage still remains one of the major complications. Objective: The primary aim of this study was to evaluate the effect of tranexamic acid (TXA) in reducing intraoperative blood loss and need for blood transfusion. Secondary parameters compared were operating time, volume of irrigation fluid used, and reduction in hemoglobin concentration. Subjects and Methods: A total of 70 eligible patients undergoing TURP were randomized based on computer generated table into two groups. The study group (1) received IV TXA 500 mg after induction of anesthesia and 500 mg in each irrigation fluid bottle (dual mode) and the control group (2) received none. Results: The mean age (68.20 vs. 66.5 years), prostate size (57 vs. 51 g), and preoperative hemoglobin (13.3 vs. 13.5 g/dl) were similar between the groups. Intraoperative blood loss in the TXA group was found to be significantly reduced (174.60 ± 125.38 ml vs. 232.47 ± 116.8; P = 0.04). Blood transfusion was required in 2.8% of cases as compared to 14.2% in controls. Operating time, volume of irrigation fluid, and postoperative reduction of hemoglobin were not significant between the groups. No complications were observed in both groups. Conclusion: In this study, we observed that TXA, when used as a combination of Intravenous and topical route, effectively reduced intra-operative blood loss and the need for transfusion. [ABSTRACT FROM AUTHOR]

Abstract Excessive intraoperative hemorrhage in the management of a giant neurofibroma can be reduced with ancillary procedures such as ligation of the feeding/nutrient artery, adopting proper intraoperative hemostatic methods, and by staging the surgery.

Background: Cesarean scar pregnancy (CSP) involves a rare form of placental attachment that often leads to life-threatening conditions. The best treatment for CSP has been debated for decades. We aimed to evaluate the different treatments for CSP and analyzed the risk factors for intraoperative hemorrhage.Methods: CSP patients treated at the Affiliated Hospital of Jiangnan University were reviewed retrospectively from January 2014 to 2020. CSP was classified into three types based on the location and shape of gestational tissue, blood flow features, and thickness of the myometrium at the incision site. The clinical characteristics, types, approaches of treatment, and clinical outcomes of CSP were analyzed.Results: A total of 55 patients were included in this study, 29 (52.7%) of whom underwent transvaginal curettage after uterine artery embolization (UAE) and 22 (40%) of whom underwent transabdominal ultrasound-guided hysteroscopic curettage (USHC) in type I and II. Four patients (7.3%) classified as type III underwent laparoscopic cesarean scar resection (LCSR). Intraoperative blood loss, blood transfusion rate, and scar diverticulum were significantly higher in type II than in type I (P < 0.05). Even though USHC showed no differences in intraoperative blood loss, length of stay, and scar diverticulum compared with curettage after UAE (P > 0.05), superiority was found in surgical time and hospitalization cost (P < 0.05). Furthermore, the type of CSP (OR = 10.53, 95% CI: 1.69–65.57; P = 0.012) and diameter of the gestational sac (OR = 25.76, 95% CI: 2.67–248.20; P = 0.005) were found to be risk factors for intraoperative hemorrhage.Conclusions: Transabdominal ultrasound-guided hysteroscopic curettage is an effective and relatively safe treatment option for patients with CSP. Type of CSP and diameter of the gestational sac were found to be associated with excessive intraoperative hemorrhage.

Excessive intraoperative hemorrhage in the management of a giant neurofibroma can be reduced with ancillary procedures such as ligation of the feeding/nutrient artery, adopting proper intraoperative hemostatic methods, and by staging the surgery. [ABSTRACT FROM AUTHOR]

Abstract Intraoperative intraocular bleeding can present a major challenge during anterior segment operations, such as cataract and glaucoma surgery. In the presence of significant intraocular bleeding, the surgeon may be unable to proceed if the bleeding cannot be controlled. Uncontrolled bleeding may also result in intraoperative or postoperative complications. Intracameral injection of phenylephrine was used in three consecutive cases of intraoperative anterior chamber bleeding during cataract surgery, one of which was combined with CyPass® Micro-Stent insertion. This resulted in complete cessation of bleeding within a minute of the injection. No further intraoperative or postoperative hemorrhage was seen. As far as we know, this is the first report of intracameral phenylephrine use intraoperatively to successfully stop anterior chamber bleeding, enabling safe completion of surgery.

Aim: We evaluated the effectiveness of intraoperative wireless ultrasonography in determining the location of uterine incision during cesarean delivery in patients with placenta previa who have sonographic adherence findings in order to assess intraoperative blood loss and maternal morbidity. Methods: A prospective study using wireless sonography, including 15 patients with previa, was conducted among women with singleton pregnancies who delivered by cesarean section between August 1, 2017, and August 30, 2019. Retrospective study for the control group included 32 patients with placenta previa who underwent cesarean section between January 1, 2016, and July 31, 2017, without wireless sonography. Patients with previa who had adherence findings in prenatal sonography were included in both groups. Logistic regression was used to identify the association between massive intraoperative bleeding loss and use of wireless ultrasound sonography. Results: Intraoperative blood loss was significantly reduced in the study group compared to that in the control group (P = 0.009). The hospital stay was significantly shorter in the study group compared to the control group (5 days vs 6 days, P < 0.001). The use of intraoperative wireless sonography (P = 0.01) had a significant association with massive intraoperative hemorrhage in multivariable analysis. Conclusion: Our study is the first study to apply a wireless ultrasound sonography device in women with placenta previa during cesarean section to examine maternal morbidity. This latest wireless ultrasound sonography device is advantageous for uterine incision guidance in women with placenta previa and improves maternal morbidity by reducing intraoperative hemorrhage. [ABSTRACT FROM AUTHOR]

Temporary vessel occlusion enables a surgeon dissect aneurysm and clip with a lower risk of intraoperative hemorrhage with the associated risk of ischemia. There are studies on permissible time of occlusion of the parent artery using temporary clip; however, the actual incidence of silent ischemic events in patients with aneurysms treated with microsurgical clipping is not well documented. We are trying to look for the association between temporary clipping and incidence of ischemia through this study. The study concluded the statistically significant association between the maximum time of single clip application and ischemia. Intermittent multiple temporary clippings can prevent ischemia instead of a single clipping of longer duration. [ABSTRACT FROM AUTHOR]

BACKGROUND：Acetabular fracture is considered to be one of the most challenging fractures because of its complex anatomical structure, which makes it more difficult to treat. At present, open reduction and internal fixation are still the standard treatment methods for displaced acetabular fractures. The patient-specific pre-contour reconstruction template made by three-dimensional {3D) printing technology combined with preoperative virtual surgery plan can reduce the invasiveness of surgery and simplify the operation process. OBJECTIVE: To evaluate the effect of 3D printing combined with virtual surgical planning in the treatment of acetabular fractures compared with traditional reduction and reconstruction of acetabular fractures. METHODS: Totally 25 patients were selected from Affiliated Hospital of Chengde Medical College from October 1, 2017 to March 1, 2018, including 14 males and 11 females, at the age of 21-60 years old. They were divided into experimental group (n=12) and control group {rr=13) by computer random grouping method. In the experimental group, printing technology combined with virtual pre-contour reconstruction plate fixation was performed. In the control group, intraoperative contour reconstruction plate fixation was conducted after reduction. Postoperative X-ray and non-contrast CT scan was used to analyze fracture reduction in two groups. After the operation, the patients in the two groups were followed up for visual analogue scale score, Majeed function score and complications. This study was approved by the Ethics Committee of Affiliated Hospital of Chengde Medical College (approval No. LL007}. RES UL TS AND CONCLUSION: (1) X-ray films showed that the reduction effect of the experimental group was better than that of the control group (P=0.038). Non-contrast C T images showed that the reduction displacement difference of the experimental group was better than that of the control group before and after operation [(12.43土7.58) mm, (9.408土8.27) mm, P < 0.05]. (2) At 6-12 months after surgery, visual analogue scale scores were lower in the experimental group than in the control group [{1.6土0.6), {3.3士1.3), P < 0.05]. There were no significant differences in Majeed function scores between the two groups in the final follow-up (P=0.079). (3) Complications, such as delayed healing, failure of internal fixation or deep vein thrombosis, were not found; and no biocompatibility adverse reactions related to the implanted device occurred in the two groups after surgery. (4} Results suggested that 3D printing technology assisted virtual operation plan can improve the reduction quality in the fixation of acetabular fracture, improve the operative effect of acetabular fracture, and reduce the postoperative pain of patients. [ABSTRACT FROM AUTHOR]

Objective: Surgery for uterine cervical fibroids is difficult because of restricted surgical access and risks such as intraoperative bleeding or injury to other organs. The internal iliac artery balloon occlusion catheter (IIABOC) provides effective hemostasis for placenta previa and atonic hemorrhage, and is increasingly used in surgery for uterine fibroids for controlling intraoperative hemorrhage. We investigated the efficacy and safety of the IIABOC for controlling intraoperative bleeding in total abdominal hysterectomies (TAH) and abdominal myomectomies (AM) for large cervical fibroids. Material and methods: From 2007 to 2014, the IIABOC was used in 22 cases (12 for TAH and 10 for AM) in which cervical fibroids fully occupied the pelvic cavity. Intraoperative blood loss, operating time, sample weight, use of blood transfusion, and injury to other organs were assessed. Result: Mean blood loss, operative time, and sample weight in the IIABOC cases were 510 mL, 178 min, and 2550 g for TAH; and 727.5 mL, 157.5 min, and 1850 g for AM. Blood loss divided by sample weight in IIABOC cases was significantly lower than that in non-IIABOC cases during the same time period, for both TAH and AM. Allogeneic blood transfusion was not necessary, and complications of injury to other organs did not occur in any of the 22 cases. Conclusions: For large cervical fibroids with limited operating space, surgery was performed under bleeding control by occlusion of the internal iliac artery with an IIABOC. This technique enables control of hemorrhage and safe operative management in gynecological surgery.

Objective: To investigate the effect of different surgical timing on the surgical treatment of renal angiomyolipoma (RAML) with rupture and hemorrhage., Methods: The demographic data and perioperative data of 31 patients with rupture and hemorrhage of RAML admitted to our medical center from June 2013 to February 2023 were collected. The surgery within 7 days after hemorrhage was defined as a short-term surgery group, the surgery between 7 days and 6 months after hemorrhage was defined as a medium-term surgery group, and the surgery beyond 6 months after hemorrhage was defined as a long-term surgery group. The perioperative related indicators among the three groups were compared., Results: This study collected 31 patients who underwent surgical treatment for RAML rupture and hemorrhage, of whom 13 were males and 18 were females, with an average age of (46.2±11.3) years. The short-term surgery group included 7 patients, the medium-term surgery group included 12 patients and the long-term surgery group included 12 patients. In terms of tumor diameter, the patients in the long-term surgery group were significantly lower than those in the recent surgery group [(6.6±2.4) cm vs. (10.0±3.0) cm, P =0.039]. In terms of operation time, the long-term surgery group was significantly shorter than the mid-term surgery group [(157.5±56.8) min vs. (254.8±80.1) min, P =0.006], and there was no significant difference between other groups. In terms of estimated blood loss during surgery, the long-term surgery group was significantly lower than the mid-term surgery group [35 (10, 100) mL vs. 650 (300, 1 200) mL, P < 0.001], and there was no significant difference between other groups. In terms of intraoperative blood transfusion, the long-term surgery group was significantly lower than the mid-term surgery group [0 (0, 0) mL vs. 200 (0, 700) mL, P =0.014], and there was no significant difference between other groups. In terms of postoperative hospitalization days, the long-term surgery group was significantly lower than the mid-term surgery group [5 (4, 7) d vs. 7 (6, 10) d, P =0.011], and there was no significant difference between other groups., Conclusion: We believe that for patients with RAML rupture and hemorrhage, reoperation for more than 6 months is a relatively safe time range, with minimal intraoperative bleeding. Therefore, it is more recommended to undergo surgical treatment after the hematoma is systematized through conservative treatment.

Objective: We investigated the efficacy of a combination of laparoscopy and bilateral uterine artery occlusion (BUAO) for the treatment of type II cesarean scar pregnancy (CSP)., Methods: Patients with type II CSP underwent laparoscopy + bilateral uterine artery embolization (control group) or laparoscopy + BUAO (study group). Data regarding the duration of surgery, intraoperative hemorrhage, postoperative complications, the duration of the hospital stay, and the costs of hospitalization were retrospectively collected. One year later, the time to the return of the β-human chorionic gonadotropin (β-hCG) concentration to normal and to the return of menstruation were compared., Results: The duration of surgery, time to the return of menstruation, and incidence of postoperative complications in the study group were significantly less than in the control group, but there was no significant difference in the time for β-hCG to return to normal or the volume of intraoperative hemorrhage. The duration of hospitalization and costs for the control group were higher than those for the study group., Conclusion: Laparoscopy in combination with BUAO is associated with minimal trauma, rapid recovery, a short duration of surgery, low cost of hospitalization, and a low postoperative complication rate. Thus, it represents a useful new surgical treatment for type II CSP., Competing Interests: Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Background: Hemostasis plays an important role in safe brain tumor resection and also reduces the risk for surgical complications. This study aimed to evaluate the efficacy of FLOSEAL®, a topical hemostatic agent that contains thrombin and gelatin granules, in brain tumor resections. Methods: We evaluated the hemostatic effect of FLOSEAL by scoring the intensity of bleeding from 1 (mild) to 4 (life threatening). We assessed the rate of success of hemostasis with 100 patients who underwent intracranial tumor resection. We also investigated the duration of the operation, the amount of intra- and postoperative bleeding, the number of hospital stays, and adverse events in patients who used FLOSEAL compared with those who did not use FLOSEAL. Results: FLOSEAL was applied to a total of 109 bleeding areas in 100 patients. A total of 95 bleeding areas had a score of 1 and 91 (96%) showed successful hemostasis. Thirteen bleeding areas scored 2 and 8 (62%) showed hemostasis with the first application of FLOSEAL. The second application was attempted with five bleeding areas and four showed hemostasis. About 94% (103/109 areas) of bleeding points successfully achieved hemostasis by FLOSEAL. Moreover, FLOSEAL significantly decreased the amount of intraoperative bleeding and postoperative bleeding as assessed with computed tomography on 1 day postoperatively compared with no use of FLOSEAL. There were no adverse events related to FLOSEAL use. Conclusion: Our results indicate that FLOSEAL is a reliable, convenient, and safe topical hemostatic agent for intracranial tumor resection. [ABSTRACT FROM AUTHOR]

Background: Buccal fat pad (BFP) excision is a procedure in which the fat pad is extracted in order to achieve a more youthful appearance.Objectives: The aim of this study was to describe an alternative technique that utilizes hydrodissection to extract the BFP.Methods: This is a controlled, prospective, randomized clinical study involving 2 groups. Group A (n = 27) underwent BFP excision with hydrodissection, during which 15 mL of a vasoconstricting anesthetic solution was injected into the BFP. Group B (n = 27) underwent BFP excision, during which 3 mL of lidocaine 2% with epinephrine was injected. All procedures were performed by the same surgeon. Variables analyzed were surgical time, intraoperative bleeding, and postoperative pain directly following surgery 2 hours after the procedure, as well as maximum pain within 72 hours of surgery and complications. Postoperative care was standardized, and patient follow-up extended over a 6-month period.Results: Pain scores for 54 patients were recorded on a visual analog scale (0-10). Mean ± standard deviation transoperative pain scores were 0.5 ± 0.8 for Group A and 1.3 ± 1.3 for Group B (P = 0.01); 2 hours postoperation the scores were 1.2 ± 0.7 for Group A and 2.6 ± 1 for Group B (P < 0.0001). Maximum pain occurred within 72 hours, and scored 1.6 ± 0.6 for Group A and 3.1 ± 1 for Group B (P < 0.0001). Mean operative time was 8:18 ± 0:47 minutes for Group A and 14:08 ± 2:28 minutes for Group B (P < 0.0001). There was a positive correlation between operative time and pain. Overall, 5.5% of patients suffered postoperative complications.Conclusions: BFP excision by hydrodissection is an effective procedure that decreases surgical times by facilitating extraction of the BFP with less manipulation, thereby resulting in decreased postoperative pain and a more tolerable recovery.Level Of Evidence:2: [ABSTRACT FROM AUTHOR]

Intraoperative intraocular bleeding can present a major challenge during anterior segment operations, such as cataract and glaucoma surgery. In the presence of significant intraocular bleeding, the surgeon may be unable to proceed if the bleeding cannot be controlled. Uncontrolled bleeding may also result in intraoperative or postoperative complications. Intracameral injection of phenylephrine was used in three consecutive cases of intraoperative anterior chamber bleeding during cataract surgery, one of which was combined with CyPass® Micro-Stent insertion. This resulted in complete cessation of bleeding within a minute of the injection. No further intraoperative or postoperative hemorrhage was seen. As far as we know, this is the first report of intracameral phenylephrine use intraoperatively to successfully stop anterior chamber bleeding, enabling safe completion of surgery. [ABSTRACT FROM AUTHOR]

Background Few studies have been published about percutaneous techniques for management of surgical bed hemorrhage during a stereotactic biopsy, a serious complication that may affect patient outcome. We describe the injection of a thrombin-gelatin matrix through the biopsy cannula as an effective method to arrest surgical bed bleeding that does not respond to conventional methods of hemostasis. Methods We prospectively documented image-guided stereotactic brain biopsy procedures in 30 awake patients between July 2014 and July 2017 at our center. Among patients presenting with intractable surgical bed bleeding, a thrombin-gelatin matrix injection through the biopsy cannula was performed. Details of the injection technique, surgical outcome, and complications were recorded. Results Among 30 documented stereotactic brain biopsies, 3 (10%) had intractable surgical bed bleeding during the procedure. In all 3 cases, thrombin-gelatin matrix was injected, and an immediate arrest of hemorrhage was achieved. None of the patients required a craniotomy or further invasive measure to achieve hemostasis. No postoperative complications were recorded. Conclusions Our preliminary results suggest that thrombin-gelatin matrix injection is a simple, safe, and effective stereotactic practice to manage persistent surgical bed bleeding that cannot be arrested by standard, conventional hemostatic methods. [ABSTRACT FROM AUTHOR]