Search

To analyze an opinion of surgeons on advisability, efficacy and choice of topical hemostatic agents.The research was based on anonymous questioning of surgeons. The questionnaires were developed by using of interactive Google Forms tool (https://www.google.ru/forms). Distribution of questionnaires and invitation of respondents to participation in research were carried out through the Internet.The study enrolled 135 surgeons. Colleagues with considerable experience and length of surgical practice prevailed: 10-15 years - 16 people; 15-20 years - 22 people; over 20 years - 38 people. Opinion of less experienced surgeons was also considered: less than 5 years - 40 people; 5-10 years - 19 people. General surgeons prevailed (49%). Hemostatic sutures (30%) and application of topical hemostatic agents (27%) were the most common methods to stop parenchymal bleeding. Efficacy of local hemostatics is confirmed by small number of cases of recurrent intraoperative bleeding (According to surgeons' opinion, local hemostatic agents are effective for parenchymal bleeding. This method may be used as basic (injury grade I by E. Moore classification) or additional method of hemostasis (grade I-III). Many respondents consider that application of topical hemostatic agent after imposing hemostatic sutures ensures the greatest efficiency of hemostasis. Moreover, placement of the agent over or under sutures seems to be the most advisable.Изучить мнение врачей-хирургов относительно рациональности, эффективности, выбора гемостатических аппликационных имплантов.В качестве основного метода исследования использовали анонимное анкетирование врачей-хирургов. Анкеты разработаны с помощью интерактивного инструмента Google Forms (https://www.google.ru/forms). Распространение анкет и приглашение респондентов к участию в опросе проводили через сеть Интернет.В опросе приняли участие 135 врачей хирургических специальностей, практикующих на базах профильных отделений лечебно-профилактических учреждений. Среди них преобладали сотрудники со значительным опытом и стажем работы: 10—15 лет (Согласно мнению опрошенных врачей-хирургов, использование локальных кровоостанавливающих средств является одним из эффективных способов гемостаза в хирургии паренхиматозных органов. Данный способ остановки кровотечения может быть использован в качестве основного (при травмах I степени согласно классификации E. Moore) или дополнительного (травмы I—III степени) методов гемостаза. Многие респонденты считают, что наибольшей эффективности гемостаза можно добиться, применяя материал после наложения гемостатического шва, причем следует помещать средство сверху или, наоборот, подложить его под шов, чтобы затянуть на нем узел, используя в качестве «амортизационной подушки».

Background Postoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability. Methods This was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15. Results The remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application. Conclusions With a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

The platelets play an important role in the normal hemostasis, and it is known that both natural and synthetic macromolecules may induce platelet activation and aggregation. Thus, the purpose of the present study was to investigate the platelet aggregating effect of five different local hemostatics. Platelet aggregation was assessed by aggregometry. Unwoven fleece of bovine collagen polymer in fibrillar form induced aggregation in combination with small amounts of platelet agonists; ADP and adrenaline. Ordinary, nonabsorbable bone wax also induced aggregation in combination with the agonists, but larger concentrations of agonists were needed. Bioerodible polyorthoester with physical properties such as bone wax, oxidized cellulose and gelatin sponge did not promote platelet aggregation.

Local hemostatics have recently been introduced for field use to control external hemorrhage. The objective of this report is to describe the initial clinical experience with QuikClot, a zeolite that works by absorbing water and concentrating coagulation factors to stop bleeding in a series of patients.Documented cases using a self-reporting survey sheet submitted by the users and first-hand detailed interviews with the users when possible.There were 103 documented cases of QuikClot use: 69 by the US military in Iraq, 20 by civilian trauma surgeons and 14 by civilian first responders. There were 83 cases involving application to external wounds and 20 cases of intracorporeal use by military and civilian surgeons. All field applications by first responders were successful in controlling hemorrhage. The overall efficacy rate was 92% with eight cases of ineffectiveness noted by physicians in morbid patients with massive injuries when the QuikClot was used as a last resort. These reported failures were thought to be a result of the coagulopathic state of the patient from massive resuscitation or the inability to get the product directly to the source of hemorrhage. When the QuikClot was applied on responsive patients, the heat generated by the exothermic reaction caused mild to severe pain and discomfort. There were three cases of burns caused by the heat generated by the QuikClot application with one case requiring skin grafting. There was one major complication from intracorporeal use caused by scar formation from a foreign body reaction.QuikClot has been effectively used by a wide range of providers in the field and hospital to control hemorrhage.