Hemostasis in surgery „All bleeding (eventually) stops“ Sandeep V. Kansal Why hemostasis is important in surgery Minimize blood loss during the operation Avoid tranfusion Manage increasing of anti -coagulated patients Reduces complications after surgery Why Hemostasis is important in surgery • Hemostasis •Primary Hemostasis –Vasocontriction –Formation of platelet plug – – •Secondary Hemostasis –Activation of coagulation cascade –Formation of permanet plug Primary hemostasis is the initial stage of hemostasis defined by the formation of a platelet plug at the site of injured blood vessels, preventing the leakage of blood. The three main components of primary hemostasis are activated platelets, von Willebrand factor (vWf), and the vessel wall. Secondary hemostasis is the second stage of hemostasis that results in the formation of a stable, fibrin clot by aggregated platelets and fibrin. Secondary hemostasis involves a number of components including cells such as platelets, fibroblasts, endothelial cells, and lymphocytes, enzymatic coagulation factors including factor XI, X, IX, VII, and II, cofactors including tissue factor, Factors V, and VIII, fibrinogen, phosphatidylserine, and calcium. Pathophysiological Aspects of Coagulation Scheme of primary haemostatic function A. Shlebak Hemostasis is a host defence mechanism that protects the integrity of the vascular system after tissue injury. It is responsible for minimissing blood loss. It is critical that formation of blood clot in response to a breach in the vascular endothelium occurs rapidly. Systemic activation of the coagulation cascade or extensive local extension of thrombosis resulting in vascular occlusion, however, should not occur. Immediate vasoconstriction of the injured vessel and reflex constriction of adjacent small arteries and arterioles are responsible for an initial slowing of blood flow to the injured area Platelet Granule Content and Their Biological Functions A. Shlebak Classical waterfall hypothesis of coagulation A. Shlebak Hemostasis Mechanical Methods of haemostasis •Direct pressure •Clamps •Ligation Clips •Sutures •Staples •Bone Wax •External bandages Ligaclip Suture ligation during laparoscopic surgery • Application of laparoscopic clips Excision of the thymus • Cauterization Methods of haemostasis Raising of superior skin flap with monopolar diathermy forceps Bipolar coagulation •Bipolar coagulation is fundamental to neurosurgery because it enables precise coagulation of small vessels without dangerous spread of the current to adjacent neural and vascular structures. –A range of bipolar forceps of different sizes and lengths should be available P. Bullock & R. Arya Liga-Sure and application of Liga-Sure. Chemical Methods of haemostasis Topical absorbable •Oxidized Regenerated Cellulose • •Gelatin Sponge or Powder • •Collagen • •Thrombin • •Fibrin Glue • Chemical hemostatic agents agents like surgicell are often using in transplant surgery, because these products control bleeding without occluding the vessel lumen and cause no thermal injuries to adjacent structures. A topical haemostat is often the technique of choice to control bleeding in the case of diffuse capillary and venous oozing. These haemostats have been used in surgical procedures for more than 30 years, however, new application forms like Surgicel fibrillar and Surgifoam powder entail different handling options. Surgical Blood Loss