BACKGROUND:Coagulopathy (CP) is a modifiable factor linked with secondary brain damage and poor outcome of traumatic brain injury (TBI). A shift towards goal-directed coagulation management has been observed recently. We investigated whether rotational thromboelastometry (ROTEM) based management could be successfully implemented in TBI patients and improve outcomes. MATERIAL AND METHODS:A prospective, case-control study was performed. Adult patients with isolated TBI requiring craniotomy were included in this study. All patients underwent standard coagulation tests (SCT). Patients were identified as either in control group or in case group. Patients in the case group were additionally tested with ROTEM to specify their coagulation status. Management of the patients in the control group was based on SCT, whereas management of patients in the case group was guided by ROTEM. Outcome measures were as follows: CP rate, protocol adhesion, blood loss, transfusions, progressive hemorrhagic injury (PHI), re-intervention, Glasgow coma score (GCS) and Glasgow outcome score (GOS) at discharge, and in-hospital mortality. RESULTS:There were 134 patients enrolled (65 patients in the control group and 69 patients in the case group). Twenty-six patients in the control group (40%) were found to be coagulopathic (control-CP subgroup) and 34 patients in the case group (49.3%) were found to be coagulopathic (case-CP subgroup). Twenty-five case-CP patients had ROTEM abnormalities triggering protocolized intervention, and 24 of them were treated. Overall ROTEM-based protocol adhesion rate was 85.3%. Postoperative ROTEM parameters of case-CP patients significantly improved, and the number of coagulopathic patients decreased. The incidence of PHI (control versus case group) and neurosurgical re-intervention (control-CP versus case-CP subgroup) was in favor of ROTEM guidance (P<0.05). Mortality and GCS and GOS at discharge did not differ significantly between groups. CONCLUSIONS:ROTEM led to consistent coagulation management, improved clot quality, and decreased incidence of PHI and neurosurgical re-intervention. Further studies are needed to confirm benefits of ROTEM in cases of TBI.

Background and Objectives: Spinal (SA) and general anesthesia (GA) are both available for lumbar disc hernia (LDH) surgery. Patient satisfaction with anesthesia service is under-investigated and may help identify areas requiring improvement, leading to better care. Materials and Methods: A prospective, non-randomized, survey-based study was performed in patients who underwent LDH surgeries under SA or GA. Patients rated perioperative pain (preoperative and postoperative days (PODs) 0, 1, and 2) and satisfaction with perioperative care (10 questions) on a numeric rating scale (NRS) from 0 to 10, and an overall satisfaction score (OSS) was calculated; a patient discomfort questionnaire was also used. Study outcomes were pain scores, satisfaction with care, and discomfort reported by SA and GA patients. Results: In total, 209 completed questionnaires in the GA and SA groups (114 vs. 95) were available for final analysis. Baseline characteristics did not differ significantly between the two groups. The proportion of patients with severe pain decreased from >80% preoperatively to 6% on POD2, and pain scores did not differ significantly between groups. Mean overall satisfaction scores (OSSs) were high: 9.71 (maximum OSS: 57% of cases) in the GA group, and 9.75 (maximum OSS: 53.7% of cases) in the SA group (p = 0.95). The ceiling effect of the patient satisfaction questionnaire had to be addressed. There was no association between the type of anesthesia and OSS. Sources of discomfort were similar between groups, except for oropharyngeal discomfort being more prevalent in the GA group (p < 0.05). Postoperative pain was reported as a source of discomfort by >50% of patients in both the SA and GA groups. Regression analysis identified anxiety and nude body exposure as preoperative factors associated with decreased satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were PONV, cold, mouth dryness, and pain. Pain on POD 0 did not influence overall patient satisfaction. An association was only found when pain persisted on POD 1 and POD 2. Conclusions: No significant differences between the two anesthesia methods were found. Patient information, anxiety management, and privacy protection are important for patient satisfaction. In the postoperative period, pain and PONV management must be equally addressed, irrespective of the anesthesia method used. Further efforts to develop optimal tools for patient satisfaction assessment are necessary.