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N O V E M B E R 2 0 1 5 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
Besides the aspirin/Plavix duo, another less celebrated bleeding induc-
er is fish oil. I had a patient who took so much fish oil with mercury that
he could take his own temperature! In their quest to lower cholesterol,
many well-meaning patients consume omega 3's without realizing their
blood will become more slippery than a freshly mopped OR floor.
Add vitamin E, turmeric and garlic to the blood-thinning all-star list.
Even ginger contains appreciable levels of salicylates! So much for
adding spice to one's life. Excessive alcohol consumption can deplete
vitamin K levels and may work better than warfarin in causing bleed-
ing. Be wary of the patient who casually drinks, but has a dog named
Coors.
• Anesthesia-linked. Hypotensive anesthesia is absolutely critical to
attaining hemostasis in surgery. But "hypotensive" means different
things to different people. Surgeons like systolic pressure less than 100
mm/Hg in a healthy adult. Many anesthesiologists like higher pressures
to ensure cerebral perfusion. But does the 16-year-old pitcher really need
a systolic of 130 to ensure cerebral blood flow? I perform my shoulder
scopes in the lateral position and, unless the patient has a carotid lumen
the size of dental floss, blood flow to the cranium should not be an issue.
Toradol is a great analgesic agent, but has the blood-thinning capability
of a heparin drip. I really don't appreciate well-meaning anesthetists
sneaking a little Toradol in before the case is completed. This simple
maneuver increases my gastric secretions and puts my epigastrium at
risk for a bleed.
• Surgeon-induced. Yes, surgical factors do affect bleeding events. Great
surgeons handle tissues with gentleness and kindness. If the surgeon is
grabbing instruments with a death grip, has all the gentleness of Conan
the Barbarian and inserts an arthroscope into a joint while uttering
touché, type and cross the patient. If the surgeon refuses to use thermal
