Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia.
The binding of fibrinogen and fibrin to platelets is important in normal hemostasis. The extent of platelet-fibrin interaction can be measured as the viscoelastic strength of clot by rotational thromboelastometry (ROTEM). In this study, we investigated the effect of fibrinogen concentration and its relative contribution to overall clot strength using ROTEM. ⋯ These in vitro and clinical data indicate that the clot strength increases in a fibrinogen concentration-dependent manner independent of platelet count, when analyzed by ROTEM. The maintenance of fibrinogen concentration is critical in the presence of thrombocytopenia. EXTEM (extrinsic activation) and FIBTEM may be useful in guiding fibrinogen repletion therapy.
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Anesthesia and analgesia · Mar 2009
The reliability of continuous noninvasive finger blood pressure measurement in critically ill children.
Continuous noninvasive arterial blood pressure can be measured in finger arteries using an inflatable finger cuff (FINAP) with a special device and has proven to be feasible and reliable in adults. We studied prototype pediatric finger cuffs and pediatric software to compare this blood pressure measurement with intraarterially measured blood pressure (IAP) in critically ill children. ⋯ Beta type continuous noninvasive arterial blood pressure monitoring using a finger cuff with brachial arterial waveform reconstruction seems reliable in hemodynamically stable critically ill children.
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Anesthesia and analgesia · Mar 2009
Automatic updating of times remaining in surgical cases using bayesian analysis of historical case duration data and "instant messaging" updates from anesthesia providers.
Operating room (OR) whiteboards (status displays) communicate times remaining for ongoing cases to perioperative stakeholders (e.g., postanesthesia care unit, anesthesiologists, holding area, and control desks). Usually, scheduled end times are shown for each OR. However, these displays are inaccurate for predicting the time that remains in a case. Once a case scheduled for 2 h has been on-going for 1.5 h, the median time remaining is not 0.5 h but longer, and the amount longer differs among procedures. ⋯ For cases taking nearly as long as or longer than scheduled, each 1 min progression of OR time reduces the median time remaining in a case by <1 min. We implemented automated calculation of times remaining for every case at a 29 OR hospital.
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Anesthesia and analgesia · Mar 2009
An absorbable local anesthetic matrix provides several days of functional sciatic nerve blockade.
Functional blockade of peripheral nerves is the primary objective of local anesthesia, and it is often desirable to have a persistent blockade, sustained throughout and beyond a surgical procedure. Current local anesthetics give effective analgesia for <8-12 h after a single bolus injection. We report on an implantable, controlled-release drug delivery system intended for use in bone and consisting of a Food and Drug Administration-approved matrix containing lidocaine that is capable of local delivery for several days. ⋯ Xybrex is an absorbable, controlled-release drug delivery system that provides several days of analgesia for rat peripheral nerves without apparent significant local neurotoxicity or systemic toxicity.