kaolinite and Blood-Loss--Surgical

This article reviews past approaches to heparin and protamine dosing and summarizes current practice. The author elucidates his experience with the Celite activated coagulation time (ACT), with attention to his adoption of a value of 400 seconds for this time; the adoption of an ACT of 480 seconds by Bull et al (J Thorac Cardiovasc Surg 69:674-684, 1975) and Young et al (Ann Thorac Surg 26:231-240, 1978); the proposed use of heparin response curves by Bull et al; the author's experience with a unitized dosing system to individualize dosing of heparin; and the use for this purpose by Despotis et al (J Thorac Cardiovasc Surg 110:46-54, 1995) of a system based on protamine titration. In more than 270 adult cardiac surgery patients, the unitized dosing system identified patients with high sensitivity or resistance to heparin and facilitated exact individualized doses to be given to produce the desired effect. Thus, less heparin was used in short bypass runs. Patients received less protamine than they would have with any other formula, and there was less blood loss and fewer transfusions required. Currently, no claims for efficacy or safety can be made for maintaining heparin concentrations greater than 3 U/mL. Pending further clarification, heparin dosage cannot be safely reduced when using heparin-bonded circuits. Aprotinin is not a procoagulant during cardiopulmonary bypass. Emerging studies suggest that graft patency is not affected by aprotinin use. The Celite ACT should not be used to monitor heparin effect and safety when using aprotinin; the kaolin ACT should be used instead.

Topics: Adult; Anticoagulants; Aprotinin; Blood Loss, Surgical; Blood Transfusion; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Coagulants; Drug Resistance; Extracorporeal Circulation; Hemostatics; Heparin; Heparin Antagonists; Humans; Kaolin; Protamines; Safety; Vascular Patency; Whole Blood Coagulation Time

Topics: Bandages; Blood Loss, Surgical; Colon; Elective Surgical Procedures; Hemostasis, Surgical; Humans; Kaolin; Laparoscopy; Rectum; Retrospective Studies; Time Factors; Treatment Outcome

A kaolin-impregnated hemostatic sponge (QuikClot) is reported to reduce intraoperative blood loss in trauma and noncardiac surgery. The purpose of this study was to assess if this sponge was effective for hemostasis during Norwood operation.. We conducted a retrospective review of patients undergoing Norwood operation in infancy between 2011 and 2016 at our institution.. Of 31 identified Norwood operations, a kaolin-impregnated sponge was used intraoperatively in 15 (48%) patients. The preoperative profiles and cardiopulmonary bypass status were similar between the operations with or without kaolin-impregnated sponge. The comparison on each operative outcome between operations with or without kaolin-impregnated sponge showed that the intraoperative platelets, cryoprecipitate, and factor VII dosage were significantly less in the operations with kaolin-impregnated sponge (55 mL, 10 mL, 0 µg/kg vs 72 mL, 15 mL, 45 µg/kg; P = .03, .021, .019), as well as the incidence of perioperative bleeding complications (second cardiopulmonary bypass for hemostasis or postoperative mediastinal exploration, 0% vs 31%, P = .043). A logistic regression model showed that the nonuse of kaolin-impregnated sponge and longer aortic cross clamp time were associated with perioperative bleeding complication in univariable model ( P = .02 and .005).. Use of kaolin-impregnated hemostatic sponge was associated with reduced blood product use and perioperative bleeding complications in Norwood operation at a single institution.

Topics: Aged; Blood Loss, Surgical; Female; Follow-Up Studies; Heart Defects, Congenital; Hemostatic Techniques; Humans; Infant; Infant, Newborn; Kaolin; Male; Middle Aged; Norwood Procedures; Retrospective Studies; Surgical Sponges; Treatment Outcome

Retrospective case-control study.. To evaluate the hemostatic benefits of using a kaolin-impregnated dressing during pediatric spinal deformity correction surgery.. Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin-impregnated hemostatic dressing.. Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46 females, 19 males, 12.7±4.5 yr, 10.2±4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33 females, 19 males, 13.9±3.2 yr, 10.4±4.3 levels fused) who underwent intraoperative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgical procedures from July 2010 to August 2011. No other major changes in the use of antifibrinolytics or perioperative, surgical, or anesthesia technique were noted. Statistical differences were analyzed using analysis of covariance in R with P value of less than 0.05. The statistical model included sex, age, weight, scoliosis type, the number of vertebral levels fused, and surgery duration as covariates.. The treatment group had 40% less intraoperative estimated blood loss than the control group (974 mL vs. 1620 mL) (P<0.001). Patients who received the QCTP treatment also had 42% less total perioperative transfusion volume (499 mL vs. 862 mL) (P<0.01).. The use of a kaolin-impregnated intraoperative trauma pad seems to be an effective and inexpensive method to reduce intraoperative blood loss and transfusion volume in pediatric spinal deformity surgery.. 3.

Topics: Adolescent; Bandages; Blood Loss, Surgical; Blood Transfusion; Child; Cost Savings; Female; Hemostatic Techniques; Hemostatics; Hospitals, Pediatric; Humans; Intraoperative Care; Kansas; Kaolin; Male; Retrospective Studies; Scoliosis; Spinal Fusion; Surgical Sponges; Tertiary Care Centers

In this study, we assessed the relationship between coagulation parameters using kaolin-activated thromboelastography (TEG®) and total estimated blood loss (EBL) in patients undergoing elective cesarean delivery (CD).. TEG® parameters were recorded in 52 patients before and after elective CD. Laboratory markers of coagulation (prothrombin time, activated partial thromboplastin time, fibrinogen) were also assessed in a smaller subset (21 patients). Correlation and linear regression analysis was used to assess the relationship among TEG® parameters, relevant clinical variables, and total EBL. Secondary analysis included comparisons of TEG® and coagulation profiles pre-CD versus post-CD.. EBL weakly correlated with percentage change in maximum amplitude (r=0.3; P=0.04) and post-CD maximum rate of thrombus generation (r=0.31; P=0.02). Post-CD values for split point, reaction time, time to maximum rate of thrombin generation, prothrombin time, and activated partial thromboplastin time were significantly increased compared with baseline values (P<0.05). Post-CD α angle, maximum amplitude, total thrombus generation, fibrinogen, and platelet counts were significantly decreased compared with baseline values (P<0.05).. There is a weak association between clot strength (as assessed by kaolin-activated TEG®) and EBL in patients undergoing elective CD under neuraxial anesthesia, and a modest reduction in the degree of maternal hypercoagulability occurs in the early postpartum period after elective CD.

Topics: Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; Biomarkers; Blood Coagulation; Blood Loss, Surgical; Cesarean Section; Elective Surgical Procedures; Female; Fibrinogen; Humans; Kaolin; Linear Models; Multivariate Analysis; Partial Thromboplastin Time; Postoperative Period; Predictive Value of Tests; Pregnancy; Preoperative Period; Prothrombin Time; Risk Assessment; Risk Factors; Thrombelastography; Time Factors