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BACKGROUND: Spinal reconstructive surgery in adults can be associated with significant blood loss, often requiring allogeneic blood transfusion. The objective of this randomized, prospective, double-blind, multicenter study was to evaluate the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss and transfusion in adult patients having elective posterior thoracic/lumbar instrumented spinal fusion surgery.

METHODS: One hundred fifty-one adult patients were randomized to receive either a bolus of 10 mg/kg IV of TXA after induction followed by a maintenance infusion of 1 mg/kg/hr of TXA, or an equivalent volume of placebo (normal saline). The primary outcome was the total perioperative estimated and calculated blood loss intraoperatively and 24 h postoperatively. Secondary outcomes were incidence of allogeneic blood exposure, and duration of hospital stay.

RESULTS: Four patients were withdrawn for identifiable surgical bleeding, therefore 147 patients were included in the analysis. The total estimated and calculated perioperative blood loss was approximately 25% and 30% lower in patients given TXA versus placebo (1592 ± 1315 mL vs 2138 ± 1607 mL, P = 0.026; 3079 ± 2558 vs 4363 ± 3030, P = 0.017), respectively. There was no difference in the amounts of blood products transfused, and length of stay between the two groups. TXA, surgical duration, and number of vertebrae fused were independent factors related to perioperative blood loss. Predictors for the need for allogeneic red blood cell transfusion were ASA classification, surgical duration and number of levels fused.

CONCLUSIONS: TXA significantly reduced the estimated and calculated total amount of perioperative blood loss in adult patients having elective posterior thoracic/lumbar instrumented spinal fusion surgery.

Ocean An Illustrated Atlas
Written by Sylvia A. Earle and Linda K. Glover

Detailing a mysterious realm that’s as vital to our existence as the air we breathe, this new atlas immerses readers in the wonders of the deep through more than 250 up-to-the-minute maps, photographs, and satellite images. Deep-sea pioneer and National Geographic Explorer-in-Residence Sylvia A. Earle (known as "Her Deepness") and marine scientist Linda K. Glover guide the adventure, in consultation with experts from NASA and the National Oceanic and Atmospheric Administration—who welcome the publication of a comprehensive ocean atlas geared to popular readers.

The accessible text lays out key concepts, points of interest, and little known facts, opening our eyes to living phenomena from giant squid to tiny microbial bodies. Astonishing full-color photographs and diagrams reveal the beauty and complexity of ocean life. Unprecedented new full spread maps of the ocean floor—hand-drawn by expert cartographers—reveal the five major oceans in astonishing details. An unequaled resource for both education and entertainment, Ocean also explores the progress of fascinating technologies that will help scientists discover uncharted regions and life-forms. In light of recent events—the tsunami of 2004, Katrina and Rita of 2005, the growth of the ozone hole—humankind’s link to the ocean is front and center in our lives today. This rich informative, and timely atlas, encourages understanding of how the ocean correlates with these happenings—and how human maintenance of its waters and creatures will keep the planet going.