الفهرس 
Physiology of haemostasis in surgery and traumaOnly 14 pages are availabe for public view
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Abstract
H
aemostasis is a key element in all operative fields in determining a successful surgical outcome, and proper surgical skills are still prerequisites in preventing bleeding. Major bleeding has to be controlled by standard surgical techniques such as stitches, ligatures or clips. Diffuse bleeding is a problem that often cannot be approached in the same way, and many new methods and tools developed in the past decades have revolutionized current practice in the operating room; surgical tools such as electrocautery, argon beamer or laser are often helpful. Other numerous systemic and local haemostatic agents have also been developed, and some are used on a daily basis in surgical routines. The application of these methods has led to the expansion of laparoscopic approaches in performing major surgical procedures (Rickenbacher et al., 2009).
Control of intraoperative blood loss requires contribution from both the surgeon and anaesthetist. Meticulous surgical haemostasis, control of blood pressure, judicious fluid replacement, maintenance of normothermia and correction of clotting factor deficiencies are the basic components of surgical field haemostasis (Mahdy and Webster, 2004).
Several types of interventions can be used to promote hemostasis in the intraoperative and perioperative periods. These include preventive measures, surgical techniques, transfusion of selected blood products, or administration of systemic or topical haemostatic agents (Boucher et al., 2009).
Transfusion of blood components remains a high-risk procedure. Each transfusion exposes patients to a variety of potentially serious complications, so unnecessary transfusions make little sense in view of the potential harm (Boucher, 2007).
Systemic pharmacological haemostatic agents may be of benefit in surgical settings associated with excessive surgical bleeding and/or hyperfibrinolysis, in patients with borderline or mild haemostatic defects, or in those who refuse blood transfusion (Mahdy and Webster, 2004).
In the last decade, advances in biotechnology have resulted in an explosive growth of topical haemostatic agents which are available to the modern surgeon. We believe that a thorough understanding of the various agents and their mechanism of action provides the basis for selecting the right agent at the right time.
It is essential to understand the mechanism of action, efficacy and possible adverse events as they relate to the most commonly used hemostatic agents, subcategorized as physical agents, absorbable agents, biologic agents, and synthetic agents. We also evaluate novel hemostatic dressings and their application in the current era. It is also important to verify efficacy from a financial point of view, particularly when expensive disposable instruments are needed (Achneck et al., 2010).
Successful haemostasis in laparoscopy has opened the surgical field of laparoscopic indications since the limitation attributable to insufficient haemostasis or conversion to open surgery related to uncontrollable bleeding during laparoscopy has become rare in centres experienced in modern haemostasis (Klingler et al., 2006).
Focusing on the urologic applications of tissue glues and haemostatic agents, they have been used in the management of genitourinary injuries, surgical wounds, urinary tract reconstruction, fistula and percutaneous tract closure and suture line strengthening (Rajbabu et al., 2007).
To date, the greatest use of topical hemostatic agents in urologic surgery has been for partial nephrectomy in the management of renal cell carcinoma (Rickenbacher et al., 2009).
In all these procedures, tissue sealants should not be viewed as a replacement for conventional sound surgical judgment or technique, but rather as complementary adjuncts to improve surgical outcomes (Achneck et al., 2010).