Intraoperative Hemostasis in Neurosurgery
Intraoperative Hemostasis in Neurosurgery
Intraoperative Hemostasis in Neurosurgery
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<strong>Intraoperative</strong> <strong>Hemostasis</strong> <strong>in</strong> <strong>Neurosurgery</strong><br />
15‐11‐2011<br />
Tomas Menovsky<br />
dept. of <strong>Neurosurgery</strong><br />
Antwerp University Hospital<br />
Belgium
•<strong>Hemostasis</strong> <strong>in</strong> neurosurgery<br />
•Methods and examples<br />
Presentation
Goal<br />
• Basic understand<strong>in</strong>g of hemostasis<br />
• Why hemostasis is so important<br />
• Knowledge of the major hemostatic methods
Surgical hemostasis ≠physiological hemostasis
Postoperative rebleed
Postoperative hemorrhage
Reasons for us<strong>in</strong>g products of <strong>in</strong>struments<br />
• it is the habit HERE<br />
• the prof. says so!<br />
• I was learned that way<br />
• I am used to it<br />
• there are no alternatives<br />
• I am conv<strong>in</strong>ced this is the best
Hemostatic methods&<strong>in</strong>struments<br />
• Mechanical<br />
• Thermal<br />
• Chemical<br />
• Physiological<br />
• Comb<strong>in</strong>ation
Woundbed
Dry and clear
Which hemostat to use?
Some remarks on surgical techniques&materials<br />
• Do YOU have the knowledge of a product?<br />
• Where does your knowledge comes from?<br />
• Does the product what is has to do or what the company promises?<br />
• Do you use the product properly?<br />
• A fool with a tool is still a fool
Type, place, and severity of the<br />
bleed<strong>in</strong>g
Type, location, and severity of the bleed<strong>in</strong>g
Hemostatic methods&<strong>in</strong>struments<br />
Type, placeOxidized cellulosis (Gelitacel-Surgicel-<br />
Traumastem)<br />
Collagens (Novacol)<br />
Gelat<strong>in</strong>s (Gelita-sponSpongostan, Gelfoam)<br />
Combi (Tachosyl-Surgiflow-Floseal)<br />
Glues (Tissucol-Histoacryl)
Hemostatic methods&<strong>in</strong>struments<br />
• Oxidized (regenerated)<br />
cellulosis<br />
–Low pH<br />
– Bacteristatical<br />
– Absorption<br />
– Granuloma’s-Surgiloma
Oxidized cellulosis
Oxidized cellulosis
Oxidized cellulosis
Oxidized cellulosis
Oxidized cellulosis
R<strong>in</strong>s<strong>in</strong>g
Remove or not to<br />
remove??
Do not leave too much foreign material <strong>in</strong> the<br />
body
Surgicel Fibrillar
Logistics of the hemostatic products
Hemostatic products and <strong>in</strong>struments <strong>in</strong> the OR
Organize the products <strong>in</strong> the OR
Read & Understand Instructions
<strong>Hemostasis</strong> is a Process
Surgery is a TEAM effort
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