Background and Objectives The idea of bloodless medicine and surgery emerged when physicians had to treat patients who defied transfusion for religious reasons (e.g. Jehovah’s Witnesses); moreover, problems in ensuring safe blood supplies, the relevant costs involved, and the post-transfusion complications gave also rise to bloodless method. The aim of this study is to evaluate the reduction of allogenic blood transfusion, postoperative infection and costs in the bloodless group compared to the control. Materials and Methods A retrospective comparative study was undertaken for patients undergoing coronary artery bypass grafting (CABG) at Isfahan’s Chamran hospital. Two groups of patients undergoing the classic CABG and the Bloodless techniques were compared (100 patients in each group). For bloodless surgery in addition to considering principles of bloodless medicine and surgery, autologous normovolemic hemodilution was done before operation (1-2 units) and patients were not transfused unless their hemoglobin was 9 gm/dl. Data were analysed by t-test and Chi-square test. Various factors were compared between these two techniques such as units of packed cells (PC) and fresh frozen plasma (FFP) transfused, length of hospital stay, costs and postoperative complications (infection, bleeding, etc.). Results In bloodless and classic surgery groups, 76% and 38% did not require PC transfusion, respectively. In addition, we observed a significant difference between FFP transfusion in the bloodless (93%) and classic technique (73%). No patient in the bloodless group received platelets whereas 2% of the patients in the classic group did. Overall length of hospital stay and ICU stay were less in the bloodless method; hence, the costs were less too. Postoperative infection was less in the bloodless method. These differences were significant. Conclusions The application of bloodless method for patients undergoing CABG significantly reduces PC and FFP consumption (P=0.001); therefore, the complications of blood transfusion such as post transfusion HIV, hepatitis, allergic and immunological reactions are decreased. Length of hospital stay and postoperative infections are also reduced which in turn reduce the costs (P=0.001, 0.001 and 0.037, respectively).

Pyogenic granuloma (PG) is a common, acquired tumor-like growth occurring on skin/mucous membranes. It is prevalent in the pediatric age group. It is benign in nature and is caused by chronic low grade trauma. It presents as pink to red elevated pedunculated or sessile mass. There are various treatment modalities including surgery, cryotherapy, laser, electrocautery, etc. However, the therapeutic effects are limited with high recurrence rates. The use of sclerotherapy for the treatment of pyogenic granuloma in children is not commonly reported. We present a case of PG on the scalp successfully treated with intralesional injection of sodium tetradecyl sulfate.

The incidence of deformities is differing from one population to another. Nevertheless, the rates reported are considerably high. Correction of deformities usually takes place by means of orthognatic surgery, orthodontic treatment or a combination of these procedures. The aim of this research was to assess the prevalence of complications following orthognatic surgical procedures in patients who had undergone this procedure.Patients were selected from those referred to Taleghani Hospital during 1993 to 1997. An existing data analysis was performed by looking up the patients case notes. Results indicated that: from the total of 101 patients, 16.9 percent were suffering from nerve injury with 4.9 percent suffering from bone segment fracture.

Introduction: Diode laser with wavelengths ranging from 810 to 980 nm in a continuous or pulsed mode was used as a possible instrument for soft tissue surgery in the oral cavity.Discussion: Diode laser is one of laser systems in which photons are produced by electric current with wavelengths of 810, 940 and 980nm. The application of diode laser in soft tissue oral surgery has been evaluated from a safety point of view, for facial pigmentation and vascular lesions and in oral surgery excision; for example frenectomy, epulis fissuratum and fibroma. The advantages of laser application are that it provides relatively bloodless surgical and post surgical courses with minimal swelling and scarring. We used diode laser for excisional biopsy of pyogenic granuloma and gingival pigmentation.Conclusion: The diode laser can be used as a modality for oral soft tissue surgery.

Bier block anesthesia is an intravenous regional anesthesia technique in which an extremity is made numb for surgery by injecting a local anesthetic solution into a vein after the blood has been squeezed out of the extremity and a tourniquet has been placed on it. The tourniquet prevents the local anesthetic from leaving the extremity and blood from entering it, giving the patient a numb (anesthetic) extremity and the surgeon a bloodless field to work in. The technique is named for August Bier.The advantages of the technique is that it is simple to perform, and provides a bloodless field that is easy to work in and minimizes blood loss. The disadvantages are that there is a practical time limit on its use of about 1 hour due to tolerance of the awake patient for the pain of the tourniquet and 2 hours due to the maximum time blood flow can be restricted to the extremity without anoxic tissue damage.In this case we performed bier block in a high risk diabetic patient for below knee amputation. We added mg sulfate as an adjuvant drug in order to improve block quality and to prolong patient analgesia.

Introduction. The antihypertensive drug clonidine is a centrally acting alpha 2 agonist useful as a premedicant because of its sedative, anxiolytic, and analgesicproperties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endoscopic sinus surgery. We also evaluated the bleeding volume, and consumption of fentanyl and hydralazine to controlL hypotension.Methods. A prospective, randomized, double blind clinical trial study was performed in 113 patients scheduled for elective endoscpic sinus surgery under general anesthesia. Fifty- two patients received clonidine (5 mic.g/kg) 90 min prior to arrival at the operating theater and 61 received placebo (control group). The hemodynamic endpoint of the anesthetic management was maintenance of hypotension at 70 mmHg (MAP) for producing a bloodless surgical field. The desired control of the cardiovascular system was attained with halothane (inspired concentration increments of 0.5 vol % up to a maximum of 1.5 vol %) +/- fentanyl (2 mic.g/kg iv) +/- hydralazin (100 mic.g/kg) iv to a maximum of 40 mg) as needed. Intraoperative bleeding was assessed on a six- point scale from 0= no bleeding to 5 = severe bleeding.Results. There was less bleeding volume in the clonidine group (mean±SD) than in the placebo group (144±75 vs 225 ±72ml, P<0.05). Frequency of score 3 and 4 (troublesome with repeated suction) was lower in the clonidine group than in the placebo group (% 12 vs %35, P <0.05). Patients in both groups required nearly equal mean inspired halothane concentration (1.32±0.24 vs 1.35±0.21 Vol %, P> 0.05). Fentanyl requirements were significantly lower (112±18 vs 142±21 mic. g, P<0.05) in the clonidine group. Hydralazine requirements were also significantly lower (0.40±1.68 vs 2.67±4.33 mg, P<0.05).Discussion. Premedication with oral clonidine reduced bleeding in endoscopic sinus surgery and also diminished fentanyl, and hydralazine requirement for controlled hypotension.

Introduction: Lasers are becoming the standard of care for many dental procedures, and are being introduced as a high-tech instrument. They are also becoming more routine in dentistry through the advent of office-based lasers, which are also simple to use within the oral cavity. Many studies have shown the competencies of laser technology for the management of benign oral lesions as these techniques allow for painless and bloodless oral surgery. Cases Report: Nine patients attending the Department of oral and maxillofacial Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran, underwent laser outpatient procedures for the surgical removal of a wide range of benign oral lesions. Regarding the history, present illnesses and clinical figures of all reported cases, the clinician ensured that the lesions were benign and after taking informed consent from every patient, he did complete the excision of lesions with diode lasers. Following the injection of local anesthesia, an 810 nm diode laser was applied for the excisional biopsy of oral lesions. The specimens were sent for histopathological evaluations and the patients were assessed on intraoperative and postoperative complications. The patients were followed up for postoperative complications at one week and 2 weeks post-treatment. Conclusions: According to our findings, a diode laser can be a choice for the outpatient treatment of oral mucosal benign lesions as this technique provides painless and almost bloodless treatment.

Introduction: Laser surgery as an alternative for conventional surgical procedure has gained special attention. Using Carbon Dioxide (CO2) laser has some benefits like less post-operative pain, swelling and infection, decrease in risk of metastasis and edema, and less bleeding providing dry sites for surgery.Case Report: A 12 years old boy with lingual frenum with indication for excision was referred to the laser department of Tehran University of medical sciences dental school.CO2 laser was used with 10600 nm wavelength, 1.5 W output power, 100 Hz frequency and 400 msec pulse duration in non-contact mode.Results: The result of using CO2 laser was dry and bloodless field during operation, no post operative swelling, no pain or discomfort, with normal healing process.Conclusion: We suggest and stimulate the use of CO2 laser for soft tissue surgery because of elimination of suture, convenient coagulation, time saving, patients’ comfort and easy manipulation.

Tranexamic acid (TA) is an antifibrinolytic agent which reduces bleeding following certain surgical procedures. The present study was performed on 56 patients, scheduled for elective endoscopic sinus surgery under general anesthesia, to examine the effects of topical TA on providing a bloodless surgical field and evaluate the bleeding volume. The study comprised 26 patients who received topical TA and 30 patients used placebo. The homodynamic endpoints were to maintain the mean arterial blood pressure at 30% bellow its preoperative level. Intraoperative bleeding was assessed using a six point scale. There was less bleeding volume in the TA group than in the placebo group (174.0±10.6 vs 229.1±23.8 ml; P<0.05). The frequency of score 3 was 26% in TA group which was significantly lower than of placebo group (70%).The bleeding score of TA group was significantly lower than of placebo group (2.3±0.2 vs. 2.5±0.15). In conclusion it seems that topical application of tranexamic acid reduces intraoperative bleeding in endoscopic sinus surgery.