Preoperative Laboratory Testing in Patients Undergoing Elective Surgery: An Analysis of Practice at Komofo Anokye Teaching Hospital
Akwasi Antwi-Kusi,
Bright Ighodaro Obasuyi,
William Addison
Issue:
Volume 5, Issue 2, March 2017
Pages:
5-10
Received:
24 February 2017
Accepted:
14 March 2017
Published:
29 March 2017
Abstract: Background: Perioperative laboratory investigations should be obtained for specific indications based on the patient history, physical examination, co morbidities and the type of surgery. A test is likely to be indicated only if it can correctly identify abnormalities and will change the diagnosis, the management plan, or the patient’s outcome. Routine laboratory investigation before surgery is rampant. It seldom however changes the anaesthetic care plan or influence outcome. This research sought to find out the practice of preoperative laboratory testing at the Komfo Anokye Teaching Hospital (K. A. T. H). Methodology: This was a prospective, cross sectional study of patients undergoing elective surgery at K. A. T. H from 1st to 31st March 2014. A quantitative technique was used to effectively quantify laboratory results that were contained in a patient’s folder before an elective surgical procedure. Close and open ended questionnaire was developed and answered by reviewing patient’s folders during the pre-anaesthesia assessment. Data were analyzed using Statistical Package of Social Sciences (SSPS) version 22. Results: The average age of patients studied was 50 years. Complete blood count (CBC) is the most ordered laboratory investigation at KATH (98.8%). Every patient had at least four (4) laboratory investigations done. At the time of preoperative assessment by the anaesthetist, laboratory investigations had already been ordered by the surgical team in almost all the patients studied (98.8%). The anaesthetists ordered investigations in only 1.2% of the patients. When tests ordered were compared to the Canadian Anesthesiology Society (CAS) guidelines, it was found that 54.4% of renal function test ordered had no indication, as was the case with serum electrolytes 40.4%, coagulation studies 39.9% and complete blood count 23.9%. Conclusion: A lot of laboratory investigations requested for patients undergoing surgery at K. A. T. H have no clinical indication. Members of the surgical team are responsible for ordering the laboratory investigations. Complete blood count is the most frequently ordered investigation.
Abstract: Background: Perioperative laboratory investigations should be obtained for specific indications based on the patient history, physical examination, co morbidities and the type of surgery. A test is likely to be indicated only if it can correctly identify abnormalities and will change the diagnosis, the management plan, or the patient’s outcome. Ro...
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The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery
Sanjeev Singh,
Anbarasu Annamalai
Issue:
Volume 5, Issue 2, March 2017
Pages:
11-18
Received:
29 January 2017
Accepted:
9 February 2017
Published:
13 April 2017
Abstract: Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral valve replacement surgeries. The aim of this study was to compare incidence of re-exploration, blood loss and blood transfusion following mitral valve replacement surgeries in patients who were administered either tranexamic acid or epsilon amino caproic acid. However their efficacy has not been studied in mitral valve replacement surgeries. This is a prospective, randomized, double blind study performed among sixty patients of either sex in the age group of 18 to 60 years scheduled for mitral valve replacement surgeries. They were randomly allocated into two groups, Group 1 (TA n=3O) tranexeamic acid 20 mg/kg body weight diluted in 20ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion of 2mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. Group 2 (EACA n=30) epsilon amino caproic acid 100 mg/kg body wt bolus diluted to 20 ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion 20mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. After admission to intensive care unit total blood loss, transfusion requirements during the first 24 hours and other complications were recorded. In our study we found that mean post operative blood loss in tranexamic acid group 416+47.74 (ml) which is lower than epsilon amino caproic acid group 489+42.12 (ml) that is statistically significant. 16 out of 30 patients in TA group i.e. 53.3% patients received transfusion, where as in EACA group 21 out of 30 patients i.e. 70% patients received transfusion. The total transfusion requirements, total donor unit exposure and financial cost of blood components are less in the tranexamic acid group. Prophylactic tranexamic acid effectively reduces perioperative blood loss in mitral valve replacement surgery.
Abstract: Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral val...
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