2 A meta-analysis Ku-0059436 nmr of 14 studies that compared blood loss and transfusion requirements in more than 2,000 normothermic and mildly hypothermic surgical patients revealed

that less than one degree of hypothermia increased blood loss during surgery by 16% (P < .009) and increased the risk of transfusion by 22% (P < .027). 11 Frequent monitoring of temperature and rewarming measures may improve hypothermia-related patient outcomes. 12 Optimal hemostasis generally occurs when surgical technique controls all surgical sources of bleeding and the patient's own coagulation system effectively seals microvascular sources of bleeding. In this favorable situation, no additional hemostatic management is necessary; however, ideal OR situations do not always transpire. Perioperative measures should be focused Fasudil cost on achieving satisfactory hemostasis without resorting to transfusion. Even when blood-product transfusion is unavoidable, the amount that needs to be administered may be minimized by implementing measures that reduce

blood loss or that enhance the patient’s own hemostatic mechanisms. Clinical options include adequate surgical technique that controls all discrete large vessel bleeding, attention to the physiologic state of the patient (eg, temperature, pH), and the use of topical hemostatic products. Hemostasis challenges and associated interventions vary in accordance with bleeding severity (ie, minimal, moderate yet controlled, uncontrolled). Achieving local hemostasis can be accomplished Fenbendazole through a variety of strategies; in cases that involve minimal or moderate bleeding, surgical teams may consider direct application of a topical hemostat

to the bleeding surface.3 Hemostasis may also be achieved endogenously by allowing the patient’s physiologic system to reach hemostasis naturally or by using supplemental techniques of compression or packing.3 Select surgical or trauma situations may require use of systemic hemostasis strategies. For example, the surgical team can anticipate and reduce bleeding problems in patients who are taking warfarin by preoperatively administering vitamin K.3 Patients receiving heparin before surgery or receiving intentional intraoperative heparin administration may require administration of protamine.3 When it is otherwise unavoidable, fresh frozen plasma, cryoprecipitate, and platelets may be replaced via transfusion to reverse preoperative or intraoperative coagulopathy.3 Factor VII, a clotting factor that accelerates clot formation, can be administered in crisis situations.3 In all cases, there is a consistent objective to support hemostasis by maintaining the patient’s normal body temperature.