Natl Med J India
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There are limited data on the management of haemostasis in patients with severe von Willebrand disease undergoing major surgery. Data on the use of cryoprecipitate in this setting are even more limited. In many developing countries cryoprecipitate is often the only available source of factor replacement. The minimum factor levels required for maintaining haemostasis after surgery have never been carefully evaluated. ⋯ The total amount of factor replaced in our patients is approximately half of what would have been used if the usual recommendations were followed. The data suggests that lower doses of cryoprecipitate could be adequate for major surgery and wound healing in severe von Willebrand disease. This will lead to lowering of costs and reducing the risk of transfusion-associated virus infection.
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The operation theatre complex of a hospital represents an area of considerable expenditure in a hospital budget and requires maximal utilization to ensure optimum cost-benefit. There is paucity of data in India on the use of available operating time and the reasons for less-than-optimal utilization have not been studied. ⋯ Delay in starting lists, under-scheduling, interruption due to emergency surgeries, administrative reasons, induction of anaesthesia and recovery policies are the main factors that account for inefficient use of operating facilities. The correction of these factors would increase the available operating time by nearly 20%.