Comparison of Intravenous Tranexamic Acid versus Combined Intravenous and Local Infiltration of Tranexamic Acid in Reducing Perioperative Blood Loss in Patients Undergoing Primary Unilateral Total Hip Arthroplasty: A Randomised Clinical Study

Introduction: The use of Tranexamic Acid (TXA) in primary unilateral Total Hip Arthroplasty (THA) is well documented. However, considering the potential side effects including deep vein thrombosis and pulmonary embolism, the ideal route of administration of TXA to patients undergoing THA is still not known. Aim: To compare the efficacy of single dose intravenous (i.v.) TXA administration versus combined intravenous and local infiltration of TXA in reducing the perioperative blood loss in primary unilateral THA patients. Materials and Methods: This prospective, randomised clinical study, was conducted in the Department of Anaesthesiology and Critical Care at Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, between October 2020 to May 2021. 60 patients were randomly allocated into two groups: the combined group C (i.v. administration of 10 mg/kg of TXA combined with local infiltration of 600 mg TXA diluted to 60 mL with normal saline) and the single i.v. group S (i.v. administration of 10 mg/kg of TXA). The perioperative blood loss was calculated in terms of three variables- intraoperative blood loss, drainage blood loss and total blood loss. The number of postoperative blood transfusions noted. Student’s t-test and Fischer’s-exact tests were applied for statistical analysis. Results: A total of 60 patients scheduled to have primary unilateral THA. Both the groups were similar in demographic features, baseline biochemical values and procedural distribution. There was a statistically significant reduction in the (mean±SD) intraoperative blood loss (697.26±221.43 mL), drain blood volume (254.66±81.36 mL) and total blood loss (952.26±263.57 mL) in the combined group C when compared to the single group S. There was no statistically significant difference (p-value=0.671) in the postoperative blood transfusion rate between the two groups. Conclusion: Intravenous combined with local infiltration of TXA significantly reduced the perioperative blood loss in patients undergoing primary unilateral THA when compared to single dose intravenous administration of TXA

Evaluation of respiratory exchange ratio (RER) for predicting postoperative outcomes in elderly patients undergoing oncological resection for gastrointestinal malignancies – A prospective cohort study

Background and Aims: Predicting complications after major oncosurgery is particularly daunting in the elderly subcategory of patients owing to factors like preexisting age-related immune cellular senescence and a significant imbalance of oxygen delivery (DO2) and consumption (VO2) characteristic of major oncological surgeries. The respiratory exchange ratio (RER) indicates DO2–VO2 balance and onset of anaerobic metabolism. We evaluated the ability of RER in predicting the occurrence of postoperative complications following geriatric oncosurgery. Materials and Methods: In the study, we enrolled 96 patients aged 65 years and above undergoing definitive surgery for gastrointestinal malignancy. The RER was calculated at predefined time points by a non-volumetric method from the respiratory parameters as RER = (end-tidal fractional carbon dioxide [FetCO2] – fraction of inspired carbon dioxide [FiCO2]/fraction of inspired oxygen [FiO2] – end-tidal fractional oxygen [FetO2]). Other indices of tissue perfusion, like central venous oxygen saturation and lactate levels, were also recorded. The patients were followed up for postsurgical complications. The predictive value of RER and other perfusion parameters was assessed and compared by appropriate statistical methods. Results: The patients who sustained major complications had a higher RER than the patients who did not sustain complications (1.47 ± 0.99 vs. 0.90 ± 0.31, P = 0.001). An intraoperative cutoff value of RER ≥0.89 was found to best predict postoperative complications at a specificity and sensitivity rate of 81.2% and 76%, respectively. End-operative partial pressure of carbon dioxide (pCO2) gap of >5.2 mm and elevated arterial lactate could also predict postsurgical complications in this age group. Conclusion: The RER can serve as a noninvasive, real-time and sensitive indicator of tissue hypoperfusion and postoperative complications in geriatric gastrointestinal oncosurgery