Comparison of the Effects of Albumin 5% versus Ringer's Lactate on Blood Loss and Coagulation after Vascular Surgery Using Thromboelastography

AIM: Comparing the effects of Albumin 5% versus Ringer's lactate on blood loss and coagulation after vascular surgery using METHODS: In this randomised study, 60 patients, aged (18-60 years) ASA physical status (I-III) undergoing vascular surgery were included in the study and randomly allocated into two groups using a random number generator, to receive either Human albumin or Ringer lactate after obtaining written informed consent. Group A received 1-2 ml per minute of human albumin 5% combined with normal saline (0.9%). Group B received Ringer's lactate only as of the main solution. Variables were measured after administration of fluids as postoperative measures. The amount of blood needed for testing was 4 ml drawn before the operation and at the end of surgery with a citrate tube (blue tube) from the venous line or using a regular needle. The standard time of 15 minutes was considered to begin processing. RESULTS: There was no statistically significant difference observed between both groups regarding demographic data, surgical wound drainage, haemoglobin level, hematocrit level and coagulation profile. Regarding ROTEM thermoelectrometry variables showed that there was no statistically significant difference was found between the two groups In-TEM variables (Ex-TEM Clotting time, TEM Clot Formation Time) but In-TEM Alpha Angel measured in degrees showed a Statistically significant difference between the two groups. P < 0.001 and Ex-TEM Maximum Clotting Firmness MCF values measured in mm, there was a statistically significant difference between the two groups P = 0.045. CONCLUSION: This study concluded that the use of human albumin (5%) in vascular surgeries before reaching the trigger point for blood transfusion didn’t improve blood loss or coagulation profile compared to the use of ringer lactate only. Therefore, ringer lactate can be used as a good replacement for human albumin. Ringer lactate is readily available and inexpensive while human albumin may be costly

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prediction of Cutting Conditions in Turning AZ61 and Parameters Optimization Using Regression Analysis and Artificial Neural Network

All manufacturing engineers are faced with a lot of difficulties and high expenses associated with grinding processes of AZ61. For that reason, manufacturing engineers waste a lot of time and effort trying to reach the required surface roughness values according to the design drawing during the turning process. In this paper, an artificial neural network (ANN) modeling is used to estimate and optimize the surface roughness (Ra) value in cutting conditions of AZ61 magnesium alloy. A number of ANN models were developed and evaluated to obtain the most successful one. In addition to ANN models, traditional regression analysis was also used to build a mathematical model representing the equation required to obtain the surface roughness. Predictions from the model were examined against experimental data and then compared to the ANN model predictions using different performance criteria such as the mean absolute error, mean square error, and coefficient of determination

Peritoneovenous Shunting as Compared with Medical Treatment in Patients with Alcoholic Cirrhosis and Massive Ascites

The optimal management of severe ascites in patients with alcoholic cirrhosis has not been defined. In a 5 1/2-year study, we randomly assigned 299 men with alcoholic cirrhosis, who had persistent or recurrent severe ascites despite a standard medical regimen, to receive either intensive medical treatment or peritoneovenous (LeVeen) shunting. We identified three risk groups: Group 1 had normal or mildly abnormal results on liver-function tests, Group 2 had more severe liver dysfunction or previous complications, and Group 3 had severe prerenal azotemia without kidney disease. For the patients who received the medical treatment and those who received the surgical treatment combined, the median survival times were 1093 days in Group 1, 222 days in Group 2, and 37 days in Group 3 (P≤0.01 for all comparisons). For all the groups combined, the median time to the resolution of ascites was 5.4 weeks for medical patients and 3.0 weeks for surgical patients (P<0.01). Within each risk group, mortality during the initial hospitalization and median long-term survival were similar among patients receiving either treatment. However, the median time to the recurrence of ascites in Group 1 was 4 months in medical patients, as compared with 18 months in surgical patients (P = 0.01); in Group 2 it was 3 months in medical patients as compared with 12 months in surgical patients (P = 0.04). The median duration of hospitalization was longer in medical patients than in surgical patients (6.1 vs. 2.4 weeks in Group 1 [P<0.001] and 5.0 vs. 3.1 weeks in Group 2 [P<0.01]). Group 3 was too small to permit a meaningful comparison. During the initial hospitalization, the incidence of infections, gastrointestinal bleeding, and encephalopathy was similar among the medical and surgical patients. We conclude that peritoneovenous shunting alleviated disabling ascites more rapidly than medical management. However, survival was closely related to the severity of the illness at the time of randomization and was not altered by shunting. (N Engl J Med 1989; 321:1632–8.) ASCITES in patients with alcoholic cirrhosis is usually treated by the administration of diuretic agents and the restriction of sodium and water. Such therapy may not be successful and can cause serious adverse effects. The insertion of a peritoneovenous shunt usually relieves the ascites promptly. 1 The use of this device is controversial because the patients continue to be at risk for other complications of cirrhosis, as well as added problems due to the shunt. 2 One previous study, in which the patients were randomly assigned to receive either medical or surgical therapy, 3 resulted in the prolongation of survival and the more . .