Canadian journal of surgery. Journal canadien de chirurgie
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Total joint arthroplasty (TJA) patients often receive allogeneic blood transfusion. The use of regional anesthesia (RA) is thought to protect against the need for blood transfusion, but many randomized trials of RA in TJA have not reached this conclusion unanimously. We sought to describe the effect of RA on allogeneic transfusion in a large retrospective TJA series. ⋯ The use of spinal anesthesia protects against allogeneic transfusion in arthroplasty of the hip but not the knee. This is consistent with what is known about the hemodynamic consequences of spinal anesthesia.
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Comparative Study
Management of spleen injuries in the adult trauma population: a ten-year experience.
Increasing awareness of the postoperative risks associated with splenectomies has led physicians and surgeons to use an alternative nonoperative strategy in handling traumatic spleen injuries. Our primary objective was to compare clinical outcomes between operative and nonoperative managements in adult patients with blunt splenic injuries. The secondary objective was to assess the changes in the patterns of managing splenic injuries in the past 10 years. ⋯ The present study has shown that nonoperative management of blunt spleen trauma has increased over time and has acceptable mortality and complication rates in selected patients. Additional prospective studies are needed to assess the feasibility and safety of nonoperative management in adult spleen injuries. Furthermore, the management of traumatic spleen injuries with respect to associated injuries, such as head injuries or intra-abdominal injuries, needs ongoing evaluation.