When anastomoses of a bypass or an aneurysm repair have been done, or when an endarterectomy has been completed, we tend to think that everything is finished and well done. And it is partly true. The most complex and demanding parts of an operation have been completed, and it is fair to feel happy and relieved. But is this the end?
The answer is a big NO. No! The operation is not finished yet. There is another part that needs to be performed as meticulously as possible. Which part is it? The hemostasis.
You need to spend as much time as you can to be sure that you have achieved the best hemostasis you can achieve. Especially when it involves elective cases and cases that have gone well until then. Take your time, and try to get the surgical field “as dry as a bone”. And when you are done, check once again. Every minute you spend on this stage will spare you hours of concern, discomfort, and pity later on.
Is there an exception to this rule? Yes, there is. If you deal with emergency cases, try to minimize the time spent. It is better for the patient to live the OR, go to the ITU, warm up, and get stabilised. This can achieve some more hemostasis. A hypothermic, acidic patient will suffer from coagulopathy regardless of how much you try to stop the diffuse bleeding.