cefamandole and Blood-Loss--Surgical

In orthopaedics where a great number of implants are in use, the chance for infection is high. To keep up the aseptic condition and giving antibiotic in the perioperative time is necessary. According to the effect on postoperative bleeding authors did compare two second generation cephalosporin, the cefamandol and the cefuroxim, which are mainly used in antibiotic prophylaxis. The gamma carboxylation of glutaminic acid is inhibited by cefamandol in the liver, which is necessary in the prothrombin synthesis. The cefuroxim is without any effect on prothrombin synthesis. The postoperative bleeding was significantly higher following cefamandol administration. According to the authors in orthopaedics, where the blood loss could be high, that type of antibiotic prophylaxis is recommended, which has no effect on bleeding.

Topics: Adult; Aged; Blood Coagulation; Blood Loss, Surgical; Cefamandole; Cefuroxime; Cephalosporins; Drug Evaluation; Female; Hip Prosthesis; Humans; Male; Middle Aged; Prothrombin; Surgical Wound Infection

In orthopaedics where a great number of implants are in use, the chance for infection is high. To keep up the aseptic condition and giving antibiotic in the perioperative time is necessary. According to the effect on postoperative bleeding authors did compare two second generation cephalosporin, the cefamandol and the cefuroxim, which are mainly used in antibiotic prophylaxis. The gamma carboxylation of glutaminic acid is inhibited by cefamandol in the liver, which is necessary in the prothrombin synthesis. The cefuroxim is without any effect on prothrombin synthesis. The postoperative bleeding was significantly higher following cefamandol administration. According to the authors in orthopaedics, where the blood loss could be high, that type of antibiotic prophylaxis is recommended, which has no effect on bleeding.

Topics: Adult; Aged; Blood Coagulation; Blood Loss, Surgical; Cefamandole; Cefuroxime; Cephalosporins; Drug Evaluation; Female; Hip Prosthesis; Humans; Male; Middle Aged; Prothrombin; Surgical Wound Infection

Infection after open heart surgery is a serious complication since eradication of infection in these cases is difficult even with appropriate antibiotic therapy. In the attempt to avoid this problem, prophylactic administration of antibiotics is common. Their relative safety and their broad spectrum of activity make cephalosporin antibiotics popular choices for prophylaxis prior to and during operations, including cardiovascular procedures. METHODS. Preoperative antibiotic prophylaxis with 2 g cefamandole was performed in a prospective randomized study including 62 male patients divided into three groups. All patients gave informed consent, and the study was approved by the ethics committee of the hospital. Patients in group 1 (n = 21) and group 2 (n = 21) underwent aortocoronary bypass (ACVB) with extracorporeal circulation (ECC), while patients in group 3 (n = 20) had carotid surgery. Anaesthesia, coronary-bypass procedures and infusion regime were standardized. The flow rate during ECC was maintained at 2.41/min/m2 and the rectal temperature between 33 degrees and 34 degrees C. Arterial and urine specimens for the determination of plasma and urine levels of cefamandole were taken at definite times. Autologous blood salvage during operation was performed with haemofiltration techniques (HF) in group 1 (HF 80, Fresenius, Bad Homburg, Germany) and with cell separation techniques (CS) in group 2 (Hemonetics III, Hemonetics). Plasma and urine cefamandole levels were measured by high-pressure liquid chromatography (HPLC). RESULTS. After administration of 2 g cefamandole mean peak levels of 404.6 +/- 141.7 micrograms/ml were seen. Because of haemodilution at the beginning of extracorporeal circulation, group 1 and 2 showed much lower cefamandole plasma levels, 22.1 +/- 11.6 micrograms/ml and 24.3 +/- 14.4 micrograms/ml, than group 3 (after the same time course), with 47.4 +/- 19.1 micrograms/ml. For all patients in group 1 and 2 prebypass time (70.3 +/- 22.4 min) and the duration of the ECC (72.3 +/- 17.7 min) were comparable. There was a significant correlation between prebypass time and cefamandole plasma levels at the beginning of extracorporeal circulation (P < 0.001). No correlation could be seen for the plasma concentration after discontinuation of the extracorporeal circulation and the duration of extracorporeal circulation. The volume of autologous red packed cells and the enclosed amount of cefamandole showed a significant difference (P < 0.001) betw

Topics: Aged; Blood Loss, Surgical; Blood Transfusion, Autologous; Cefamandole; Cell Separation; Coronary Artery Bypass; Extracorporeal Circulation; Hemofiltration; Humans; Male; Middle Aged; Premedication; Prospective Studies