Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialTranexamic acid and aprotinin in primary cardiac operations: an analysis of 220 cardiac surgical patients treated with tranexamic acid or aprotinin.
Antifibrinolytics are widely used in cardiac surgery to reduce bleeding. Allogeneic blood transfusion, even in primary cardiac operations with low blood loss, is still high. In the present study we evaluated the impact of tranexamic acid compared to aprotinin on the transfusion incidence in cardiac surgical patients with low risk of bleeding. ⋯ Considering the rate of transfusion of red blood cells, tranexamic acid was slightly inferior in patients undergoing CABG, but there was no difference in patients receiving AVR. Tranexamic acid seems to be less effective in operations with increased bleeding such as CABG. Clinical benefit depends on specific patient and institution characteristics (ClinicalTrials.gov NCT00396760).
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialA randomized controlled trial of cell salvage in routine cardiac surgery.
Previous trials have indicated that cell salvage may reduce allogeneic blood transfusion during cardiac surgery, but these studies have limitations, including inconsistent use of other blood transfusion-sparing strategies. We designed a randomized controlled trial to determine whether routine cell salvage for elective uncomplicated cardiac surgery reduces blood transfusion and is cost effective in the setting of a rigorous transfusion protocol and routine administration of antifibrinolytics. ⋯ In patients undergoing routine first-time cardiac surgery in an institution with a rigorous blood conservation program, the routine use of cell salvage does not further reduce the proportion of patients exposed to allogeneic blood transfusion. However, patients who do not have excessive bleeding after surgery receive significantly fewer units of blood with cell salvage. Although the use of cell savage may reduce the demand for blood products during cardiac surgery, this comes at an increased cost to the institution.
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialIntravascular injection during ultrasound-guided axillary block: negative aspiration can be misleading.
Needle visualization is an advantage of ultrasound-guided nerve blocks compared to traditional methods of nerve localization. However, visualization of local anesthetic spread is also important. ⋯ The ultrasound transducer was removed from the patient's arm and venous blood was aspirated from the nerve block needle. Pressure applied to an ultrasound transducer can occlude venous structures making negative aspiration of blood unreliable for excluding intravascular needle placement.
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialA vein entry indicator device for facilitating peripheral intravenous cannulation in children: a prospective, randomized, controlled trial.
Vascular access is often technically difficult in children because of the small caliber and impalpability of the veins. In this study, we sought to determine if use of the Vein Entry Indicator Device (VEIDtrade mark) in children facilitates peripheral venous access. ⋯ The VEID facilitates the insertion of peripheral venous cannulas in healthy children with intermediate/difficult veins undergoing same-day surgery, reducing the number of attempts and the overall time required.
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Anesthesia and analgesia · Nov 2008
A thromboelastometric evaluation of the effects of hypothermia on the coagulation system.
Hypothermia may be accidental or therapeutic. Therapeutic hypothermia is increasingly used as treatment for various conditions, e.g., neuroprotection after cardiac arrest. Hypothermia leads to an impairment of the coagulation system, but the degree of impairment has been difficult to determine. Most studies have been performed on plasma instead of whole blood. We therefore evaluated whole blood investigating the effects of hypothermia on the coagulation system over a wide range of temperatures (25-40 degrees C). ⋯ Evaluation using a whole blood analysis shows that hypothermia progressively impairs the coagulation system.