Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1996
Case ReportsGastropleural fistula: an unusual cause of intractable postoperative nausea and vomiting.
Gastropleural fistula is an uncommon finding (1). Gastropleural fistulae have been reported after pulmonary resection (1), perforated paraesophageal hernia (2), perforated malignant gastric ulcer at the fundus, and gastric bypass operation for morbid obesity. We present a case of gastropleural fistula that resulted acutely from intractable postoperative nausea and vomiting after ambulatory knee arthroscopic surgery under general anesthesia.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Clinical TrialTranexamic acid reduces transfusions and mediastinal drainage in repeat cardiac surgery.
The administration of tranexamic acid (TA) prior to cardiopulmonary bypass (CPB) has been associated with reduced bleeding during and after cardiac surgery. In a prospective, randomized, controlled, double-blind clinical trial, adult patients undergoing repeat open heart surgery received TA (n = 17) or an equal volume of saline placebo (n = 13). In the TA group, a 20-mg/kg intravenous (IV) initial dose of TA at akin incision was followed by an infusion of 2 mg.kg-1.h-1, which continued for the duration of the surgical procedure. ⋯ Sternal closure occurred in 41 +/- 21 min in the TA group and 61 +/- 49 min in the placebo group (P = 0.14), and the subjective bleeding score was less in the TA group than in the placebo group (2.38 +/- 0.78 vs 3.08 +/- 1.04; P = 0.045). The data from the current study support the prophylactic use of TA in patients undergoing repeat cardiac surgery. TA administered prior to CPB reduced the incidence of allogeneic transfusions and postoperative mediastinal tube drainage, and improved the subjective assessment of post-CPB hemostasis in a group of patients at moderately high risk for perioperative bleeding.