Anesthesiology
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Randomized Controlled Trial Clinical Trial
Influence of high-dose aprotinin on anticoagulation, heparin requirement, and celite- and kaolin-activated clotting time in heparin-pretreated patients undergoing open-heart surgery. A double-blind, placebo-controlled study.
Aprotinin causes a prolongation of the celite-activated clotting time (CACT), but not of the kaolin-activated clotting time (KACT). Therefore, concern has been raised regarding the reliability of CACT to monitor anticoagulation in the presence of aprotinin. The current study was designed to test the efficacy of aprotinin to improve anticoagulation, and to investigate whether the prolongation of CACT reflects true anticoagulation or is an in vitro artifact. To elucidate this antithrombotic effect of aprotinin, this study was done in patients prone to reduced intraoperative heparin sensitivity. ⋯ Aprotinin treatment in combination with heparin leads to less thrombin generation during CPB. Aprotinin has anticoagulant properties. Celite-activated ACT is reliable for monitoring anticoagulation in the presence of aprotinin, because the prolonged CACT in the aprotinin group reflects improved anticoagulation. Kaolin-activated ACT does not reflect this effect of aprotinin.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Effects of acadesine on the incidence of myocardial infarction and adverse cardiac outcomes after coronary artery bypass graft surgery. Multicenter Study of Perioperative Ischemia (McSPI) Research Group.
Acadesine (AICA riboside) (5-amino-1-[beta-D-ribofuranosyl]imidazole-4-carboxamide) is a purine nucleoside analog belonging to a new class of agents generally termed adenosine regulating agents (ARAs) that increase the availability of adenosine locally in ischemic tissues. The effects of acadesine on the incidence of fatal and nonfatal myocardial infarction (MI) an on the incidence of all adverse cardiovascular outcomes (cardiac death, MI, congestive heart failure, life-threatening dysrhythmia, or cerebrovascular accident) was investigated in patients undergoing coronary artery bypass graft (CABG) surgery. ⋯ The results of this trial did not demonstrate a statistically significant difference between acadesine and placebo using the prespecified criterion for MI. Of interest are the results of the post hoc analysis, using the more specific criterion for MI, which indicate that acadesine may reduce the incidence of larger Q-wave infarctions after coronary artery bypass surgery. A second trial is underway to evaluate this contention.
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Randomized Controlled Trial Clinical Trial
Effects of perioperative analgesic technique on rate of recovery after colon surgery.
Choice of perioperative analgesia may affect the rate of recovery of gastrointestinal function and thus duration and cost of hospitalization after colonic surgery. ⋯ Epidural analgesia with bupivacaine and morphine provided the best balance of analgesia and side effects while accelerating postoperative recovery of gastrointestinal function and time to fulfillment of discharge criteria after colon surgery in relatively healthy patients within the context of a multimodal recovery program.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spontaneous ventilation with halothane in children. A comparative study between endotracheal tube and laryngeal mask airway.
It has been reported that, in children breathing spontaneously via an endotracheal tube, halothane depresses ventilation with paradoxic inspiratory movement. Endotracheal tubes have a higher airflow resistance than do laryngeal mask airways (LMAs). Therefore, the aim of this study was to compare spontaneous ventilation via the LMA with that via the endotracheal tube in children anesthetized with halothane. ⋯ In 6-24-month-old children anesthetized with halothane, paradoxic inspiratory movement is less when breathing through an LMA than through an endotracheal tube.
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Randomized Controlled Trial Clinical Trial
Enzymatic antagonism of mivacurium-induced neuromuscular blockade by human plasma cholinesterase.
Mivacurium chloride is a bis-benzylisoquinolinium nondepolarizing neuromuscular blocking agent, hydrolyzed by butyrylcholinesterase (PCHE). The dose-response relationships for PCHE after mivacurium have not been studied. Therefore, this study was designed to establish dose-response relationships for PCHE as an antagonist of mivacurium-induced neuromuscular blockade. ⋯ Administration of exogenous PCHE equivalent to activity present in 25 ml/kg of human plasma (in a 65-kg patient, this dose is equivalent to PCHE activity of 1,625 ml of adult human plasma) resulted in reliable antagonism of mivacurium-induced neuromuscular blockade. Nevertheless, because of the prohibitive cost of this compound, this reversal modality is unlikely to have a routine practical application at this time.