.: ORİJİNAL ARAŞTIRMA
Vertebra Cerrahisinde İntraoperatif Yüksek Doz Traneksamik Asit İnfüzyonu: Klinik Deneyimlerimiz
Intraoperative High-Dose Tranexamic Acid Infusion in Vertebral Surgeries: Our Clinical Experiences
Turkiye Klinikleri J Med Sci. 2020;40(3):277-84
doi: 10.5336/medsci.2020-73734
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: We aimed to share our experiences on perioperative blood loss and the prevalence of side effects of high-dose tranexamic acid (TXA) used intraoperatively in vertebral surgeries. Material and Method: Thirty-four patients with the class of American Society of Anaesthesiology(ASA) I'III who underwent posterior spinal instrumentation and osteotomy at ≥5 vertebral levels were retrospectively analysed. TXA was administered intravenously from beginning to end of surgery at a loading dose of 50 mg/kg and a maintenance dose of 10 mg/kg/h. In addition to routine monitoring, minimal invasive cardiac output measurement was also used. Operative parameters, intraoperative-postoperative blood loss, mean volume of blood transfusion and fluids, hospitalization time, Hb, BUN, creatinine, Plt, INR levels, side effects and complications were recorded and evaluated. Results: Median value of fused spinal segments was 12 (7-13). Intraoperative blood loss was 1448.53±767.18 ml, 133.85±61.77 ml per fused spinal segment and 172.79±82.12 ml per hour during the operation. While intraoperative blood loss was significantly lower in patients undergoing primary surgery than in revision patients, there was no difference in terms of postoperative blood loss. It was directly correlated with the number of fused vertebrae, duration of surgery, age and ASA. Mean amount of red blood cell transfused was 1.5±1.29U. There were no significant complications or side effects such as thromboembolism, seizure or renal failure in our patients. Conclusion: Although appropriate dosages are not yet established, we think that a loading dose of 50 mg/kg TXA can be used safely in vertebral surgeries without causing significant side effects.
Keywords: Tranexamic acid; scoliosis; spinal fusion; blood loss, surgical; antifibrinolytic agents
Objective: We aimed to share our experiences on perioperative blood loss and the prevalence of side effects of high-dose tranexamic acid (TXA) used intraoperatively in vertebral surgeries. Material and Method: Thirty-four patients with the class of American Society of Anaesthesiology(ASA) I'III who underwent posterior spinal instrumentation and osteotomy at ≥5 vertebral levels were retrospectively analysed. TXA was administered intravenously from beginning to end of surgery at a loading dose of 50 mg/kg and a maintenance dose of 10 mg/kg/h. In addition to routine monitoring, minimal invasive cardiac output measurement was also used. Operative parameters, intraoperative-postoperative blood loss, mean volume of blood transfusion and fluids, hospitalization time, Hb, BUN, creatinine, Plt, INR levels, side effects and complications were recorded and evaluated. Results: Median value of fused spinal segments was 12 (7-13). Intraoperative blood loss was 1448.53±767.18 ml, 133.85±61.77 ml per fused spinal segment and 172.79±82.12 ml per hour during the operation. While intraoperative blood loss was significantly lower in patients undergoing primary surgery than in revision patients, there was no difference in terms of postoperative blood loss. It was directly correlated with the number of fused vertebrae, duration of surgery, age and ASA. Mean amount of red blood cell transfused was 1.5±1.29U. There were no significant complications or side effects such as thromboembolism, seizure or renal failure in our patients. Conclusion: Although appropriate dosages are not yet established, we think that a loading dose of 50 mg/kg TXA can be used safely in vertebral surgeries without causing significant side effects.
Keywords: Tranexamic acid; scoliosis; spinal fusion; blood loss, surgical; antifibrinolytic agents
ÖZET
Amaç: Vertebra ameliyatlarında intraoperatif olarak kullanılan yüksek dozda traneksamik asitin (TXA) perioperatif kan kaybı ve yan etkilerin yaygınlığı konusundaki deneyimlerimizi paylaşmayı amaçladık. Gereç ve Yöntemler: Amerikan Anesteziyoloji Derneği (ASA) I-III, ≥5 seviye posterior spinal enstrümantasyon ve osteotomi uygulanmış, 34 hasta retrospektif olarak incelendi. TXA 50 mg/kg yükleme ve 10 mg/kg/saat idame dozda cerrahi başından sonuna kadar intravenöz olarak uygulanmıştı. Rutin monitörizasyona ek olarak minimal invaziv kardiyak output ölçümü de kullanıldı. Ameliyat parametreleri, intraoperatif-postoperatif kan kaybı, ortalama kan transfüzyonu ve sıvı hacmi, hastanede yatış süresi, Hb, BUN, kreatinin, Plt, INR düzeyleri, yan etkiler ve komplikasyonlar kaydedildi ve değerlendirildi. Bulgular: Füzyon uygulanan omurga segmentlerinin median değeri 12 (7-13) idi. İntraoperatif kan kaybı operasyon sırasında 1448.53 ± 767.18 ml, füzyon uygulanan spinal segment başına 133.85 ± 61.77 ml ve operasyon süresine göre saatte 172.79 ± 82.12 ml idi. Primer cerrahi geçiren hastalarda intraoperatif kan kaybı revizyon hastalarına göre anlamlı olarak düşük olmakla birlikte, postoperatif kan kaybı açısından fark yoktu. Spinal segment sayısı, ameliyat süresi, yaş ve ASA ile doğru orantılıydı. Transfüze edilen ortalama kırmızı kan hücresi miktarı 1.5 ± 1.29 U idi. Hastalarımızda tromboemboli, nöbet veya böbrek yetmezliği gibi önemli bir komplikasyon ve yan etki ile karşılaşılmamıştı. Sonuç: Uygun dozajlar henüz belirlenmemesine rağmen, vertebra ameliyatlarında TXA'in 50 mg / kg yükleme dozunun önemli yan etkilere neden olmadan güvenle kullanılabileceğini düşünmekteyiz.
Anahtar Kelimeler: Traneksamik asit; skolyoz; spinal füzyon; kan kaybı,cerrahi; antifibrinolitik ajanlar
Amaç: Vertebra ameliyatlarında intraoperatif olarak kullanılan yüksek dozda traneksamik asitin (TXA) perioperatif kan kaybı ve yan etkilerin yaygınlığı konusundaki deneyimlerimizi paylaşmayı amaçladık. Gereç ve Yöntemler: Amerikan Anesteziyoloji Derneği (ASA) I-III, ≥5 seviye posterior spinal enstrümantasyon ve osteotomi uygulanmış, 34 hasta retrospektif olarak incelendi. TXA 50 mg/kg yükleme ve 10 mg/kg/saat idame dozda cerrahi başından sonuna kadar intravenöz olarak uygulanmıştı. Rutin monitörizasyona ek olarak minimal invaziv kardiyak output ölçümü de kullanıldı. Ameliyat parametreleri, intraoperatif-postoperatif kan kaybı, ortalama kan transfüzyonu ve sıvı hacmi, hastanede yatış süresi, Hb, BUN, kreatinin, Plt, INR düzeyleri, yan etkiler ve komplikasyonlar kaydedildi ve değerlendirildi. Bulgular: Füzyon uygulanan omurga segmentlerinin median değeri 12 (7-13) idi. İntraoperatif kan kaybı operasyon sırasında 1448.53 ± 767.18 ml, füzyon uygulanan spinal segment başına 133.85 ± 61.77 ml ve operasyon süresine göre saatte 172.79 ± 82.12 ml idi. Primer cerrahi geçiren hastalarda intraoperatif kan kaybı revizyon hastalarına göre anlamlı olarak düşük olmakla birlikte, postoperatif kan kaybı açısından fark yoktu. Spinal segment sayısı, ameliyat süresi, yaş ve ASA ile doğru orantılıydı. Transfüze edilen ortalama kırmızı kan hücresi miktarı 1.5 ± 1.29 U idi. Hastalarımızda tromboemboli, nöbet veya böbrek yetmezliği gibi önemli bir komplikasyon ve yan etki ile karşılaşılmamıştı. Sonuç: Uygun dozajlar henüz belirlenmemesine rağmen, vertebra ameliyatlarında TXA'in 50 mg / kg yükleme dozunun önemli yan etkilere neden olmadan güvenle kullanılabileceğini düşünmekteyiz.
Anahtar Kelimeler: Traneksamik asit; skolyoz; spinal füzyon; kan kaybı,cerrahi; antifibrinolitik ajanlar
REFERANSLAR:
- Fletcher ND, Shourbaji N, Mitchell PM, Oswald TS, Devito DP, Bruce RW. Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis. J Child Orthop. 2014;8(3):257-63. [Crossref] [PubMed] [PMC]
- Ialenti MN, Lonner BS, Verma K, Dean L, Valdevit A, Errico T. Predicting operative blood loss during spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop. 2013;33(4):372-6. [Crossref] [PubMed]
- Goodnough LT, Maggio P, Hadhazy E, Shieh L, Hernandez-Boussard T, Khari P, et al. Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion. 2014;54(10 Pt 2):2753-9. [Crossref] [PubMed]
- Goobie SM, DiNardo JA, Faraoni D. Relationship between transfusion volume and outcomes in children undergoing noncardiac surgery. Transfusion. 2016;56(10):2487-94. [Crossref] [PubMed]
- Borden TC, Bellaire LL, Fletcher ND. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach. J Multidiscip Healthc. 2016;9:435-45. [Crossref] [PubMed] [PMC]
- Bible JE, Mirza M, Knaub MA. Blood-loss management in spine surgery. J Am Acad Orthop Surg. 2018;26(2):35-44. [Crossref] [PubMed]
- Aykaç ZZ, Arslantaş MK. [Fluid therapy and management (II) monitoring and prediction of fluid responsiveness]. GKDA Derg. 2018;24(1):1-10.
- Dhawale AA, Shah SA, Sponseller PD, Bastrom T, Neiss G, Yorgova P, et al. Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis? Spine (Phila Pa 1976). 2012;37(9):E549-55. [Crossref] [PubMed]
- Goobie SM, Zurakowski D, Glotzbecker MP, McCann ME, Hedequist D, Brustowicz RM, et al. Tranexamic acid is efficacious at decreasing the rate of blood loss in adolescent scoliosis surgery: a randomized placebo-controlled trial. J Bone Joint Surg Am. 2018;100(23):2024-32. [Crossref] [PubMed]
- Oetgen ME, Litrenta J. Perioperative blood management in pediatric spine surgery. J Am Acad Orthop Surg. 2017;25(7):480-8. [Crossref] [PubMed]
- Shapiro F, Zurakowski D, Sethna NF. Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis. Spine (Phila Pa 1976). 2007;32(20):2278-83. [Crossref] [PubMed]
- Lykissas MG, Crawford AH, Chan G, Aronson LA, Al-Sayyad MJ. The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: a single-surgeon experience. J Child Orthop. 2013;7(3):245-9. [Crossref] [PubMed] [PMC]
- Sui WY, Ye F, Yang JL. Efficacy of tranexamic acid in reducing allogeneic blood products in adolescent idiopathic scoliosis surgery. BMC Musculoskelet Disord. 2016;17:187. [Crossref] [PubMed] [PMC]
- Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology. 2005;102(4):727-32. [Crossref] [PubMed]
- Cheriyan T, Maier 2nd SP, Bianco K, Slobodyanyuk K, Rattenni RN, Lafage V, et al. Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J. 2015;15(4):752-61. [Crossref] [PubMed]
- Verma K, Errico T, Diefenbach C, Hoelscher C, Peters A, Dryer J, et al. The relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: a prospective randomized trial. J Bone Joint Surg Am. 2014;96(10):e80. [Crossref] [PubMed]
- Peters A, Verma K, Slobodyanyuk K, Cheriyan T, Hoelscher C, Schwab F, et al. Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial. Spine (Phila Pa 1976). 2015;40(8):E443-9. [Crossref] [PubMed]
- Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001;93(1):82-7. [Crossref] [PubMed]
- Grant JA, Howard J, Luntley J, Harder J, Aleissa S, Parsons D. Perioperative blood transfusion requirements in pediatric scoliosis surgery: the efficacy of tranexamic acid. J Pediatr Orthop. 2009;29(3):300-4. [Crossref] [PubMed]
- Karski JM, Dowd NP, Joiner R, Carroll J, Peniston C, Bailey K, et al. The effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32 degrees C). J Cardiothorac Vasc Anesth. 1998;12(6):642-6. [Crossref] [PubMed]
- Lecker I, Wang DS, Whissell PD, Avramescu S, Mazer CD, Orser BA. Tranexamic acid-associated seizures: causes and treatment. Ann Neurol. 2016;79(1):18-26. [Crossref] [PubMed] [PMC]
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