Surgical technology international
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Review Comparative Study
Haemostasis using a ready-to-use collagen sponge coated with activated thrombin and fibrinogen.
Adequate haemostasis is an important part of any surgical procedure, but particularly so in the case of visceral organ surgery where apparently insignificant ooze can ultimately result in significant haemorrhage and coagulopathy. To achieve haemorrhage control, the surgeon may use conventional techniques (eg, suture ligation, diathermy, and swab compression), but failing this has the option of using physical coagulation tools (eg, the argon beam coagulator) and haemostasis adjuncts (eg, fibrin glues and collagen sheets). Advances in manufacturing have led to development of several other haemostatic products including absorbable gelatin sponges, cyanoacrylates, and polymer-based adhesives. ⋯ It may be applied directly to the bleeding surface, without the need for preparation or reconstitution. This chapter reviews the published evidence and compares its use to other classes of haemostasis adjuncts across a range of surgical specialties, namely hepatic, splenic, thoracic, vascular, and minimally invasive surgery. It also aims to highlight the apparent advantages and limitations of the fibrinogen and thrombin-coated collagen sponge compared to other commercially available haemostasis adjuncts, and identify potential applications for the product.
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An Hypothermia is defined as a decrease in core temperature below 35 degrees C. The well-described deleterious effects of accidental hypothermia on outcome in multiple-trauma patients contrast the beneficial effect of controlled hypothermia on organ function during ischemia in elective surgery. Experimental studies have shown that induced hypothermia during hemorrhagic shock might have beneficial effects on outcome. ⋯ Together with this immunosuppressive profile, coagulopathy and bleeding might limit the use of induced hypothermia after multiple trauma and elective surgery. The purpose of this Chapter is to highlight current knowledge regarding the interaction of hypothermia and posttraumatic immune reactivity. A better understanding of these mechanisms would assist the introduction of preventive and therapeutic strategies into clinical practice.