13. Hemostasis

Question 1

What are the advantages of hemostasis?

Answer 1

• better visualization of tissue planes and structures
• minimizes surgical time
• decreases complications

Question 2

what are the 2 pneumatic cuffs (tourniquets) used?

Answer 2

thigh cuffs

ankle cuffs

Question 3

what is the prefereed tournique to use for hemostasis/

Answer 3

pneumatic thigh cuff

Question 4

when using thigh cuffs, what type of anesthesia must be used?

Answer 4

general or spinal anesthesia is required

Question 5

pneumatic thigh cuff should not exceed what pressure?

what about for ankle cuffs?

Answer 5

thigh cuffs- 500 mmHg

ankle cuffs- 250 mmHg

Question 6

what kind of ankle anesthesia is used for ankle cuffs ?

Answer 6

can be used with all forms of anesthesia

Question 7

how can you exsanguinate the blood in the limb?

Answer 7

elevate extremity
at 45 deg (for 3 min)
at 60 deg (for 2 min)
*or may use an esmarch or ace wrap

Question 8

what are contraindications of using all types of cuffs?

Answer 8

• infection
• malignancy
• thromboembolic disase
• a prior endovascular procedure

Question 9

what is the maximum time that a cuff can be used?

Answer 9

approx 2-3 hours
(preferrably 2 hours)
but studies have shown that max. of 1.5 hours is best for cellular recovery

Question 10

What are the local changes seen with tourniquet use?

Answer 10

increased acidity (dec pH)
decrease PO2
increased PCO2

Question 11

What are the systemic changes seen with tournqiuet use?

Answer 11

• volume overload
• acid base disturbances
• bilateral thigh cuff complciations (MI, CV collapse, pulmonary edema, HTN)

Question 12

what complciations are seen with all tourniquets?

Answer 12

• thrombosis
• inflammation
• paralysis
• tissue necrosis
• circulatory volume overload

Question 13

what are the concentrations of anesthetic/vasoconstrictor used?

Answer 13

1: 100,000
1: 200,000

Question 14

vasoconstrictors bind what receptors?

Answer 14

alpha-adrenergic

Question 15

the addiiton of a vasoconstrictor such as an epinephrine has what benefit to hemostasis?

Answer 15

permits a higher allowable dose of local anesthetic

Question 16

which hemostatic agent clots fibrinogen of blood?

Answer 16

topical thrombin (Evithrom)

Question 17

which hemostatic agent is absorbable and is a mechanical matrix that promotes clotting as well acts as a physical compression barrier?

Answer 17

gelfoam (absorbable gelatin sponge)

Question 18

which hematologic agent works by attracting platelets?

Answer 18

avitene (microfibrillar collagen)

Question 19

which hematologic agent may be utilized in patients undergoing heparin and aspirin therpay?

Answer 19

avitene (microfibrillar collagen)

Question 20

which hematologic agent has bactericidal properties?

Answer 20

surgicel

an oxygen-regenerated cellulose

Question 21

which hematologic agent works by binding to bleeding areas to coagulate vessels and its exapnsion aids in compressing the area?
(its hemostasis properties are based on physical properties rather than chemical)

Answer 21

surgicel (an oxygen-regenerated cellulose)

Question 22

which hemostatic agent is a matrix composed of two independent hemostatic agents?

Answer 22

floseal

Question 23

which hemostatic agent is used when there is excessive bleeding?

Answer 23

floseal stops bleeding within 2 minutes

Question 24

what is evicel?

Answer 24

a fibrin sealant (combination of human fibrinogen and human thrombin) in a syringe

Question 25

where in the coagulation cascade does floseal act?

Answer 25

promotes contact activation and promotes fibrin formation from fibrinogen with the help of thrombin

Question 26

which hemostatic agent acts as a physical barrier and may inhibit bone healing?

Answer 26

bone wax