004: Management Of Interoperative Bleeding

In Episode 4, Dr. Kirk covers the important topic of managing bleeding during and after oral surgery procedures. He provides an overview of key considerations and his techniques for controlling hemorrhage when it occurs in the office setting.

Prevention

Russell emphasizes that prevention is the first priority when it comes to bleeding. Steps include:

• Thorough health history and medication review - look for anticoagulant use, bleeding disorders, etc.
• For warfarin patients, check the INR close to surgery and keep it around 2.8 if possible.
• Stop aspirin 7 days prior to prevent platelet dysfunction.
• Consult prescribing doctors about holding anticoagulants like Brilinta or Eliquis.
• Understand risks in bleeding disorders and have treatment plan (DDAVP, TXA, platelets, etc).
• Consider extent of surgery - more invasive procedures increase bleeding risk.

Even with prevention, significant bleeding can still occur as Russell illustrates in a case example.

Managing Acute Bleeding

When bleeding arises despite preventive efforts, Russell uses a stepwise approach:

1. Direct pressure - Often stops minor bleeding within 5-10 minutes.
2. Epinephrine - Infiltrate epi around surgical site for vasoconstriction.
3. Hemostatic gauze - Pack extraction site and suture closed. Maintain pressure.
4. Bone wax - For bony bleeding, apply bone wax for hemostasis.
5. Diode laser - Russell's top tool for coagulating soft tissue, vessels, and bone.

With brisk bleeding, Russell proceeds rapidly through these options until hemorrhage is controlled.

For post-op bleeding, he removes any dressings, explores the site, and employs these techniques again as needed. The diode laser reliably stops recurrent hemorrhage.

Rarely, a previously undiagnosed bleeding disorder is discovered when a young patient bleeds excessively after routine extractions. Quick action and referral is key.

Conclusion

While we strive to prevent surgical bleeding through vigilant pre-op planning and precautions, unexpected hemorrhage still occurs. Being equipped with a logical protocol and tools like a diode laser enables reliably controlling bleeds when they arise. Russell welcomes any other tips listeners have found helpful at [email protected].