Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2010
Temporally and regionally disparate differences in plasmin activity by tranexamic acid.
A major complication associated with cardiac surgery is excessive and prolonged bleeding in the perioperative period. Improving coagulation by inhibiting fibrinolysis, primarily through inhibition of plasmin activity (PLact) with antifibrinolytics such as tranexamic acid (TXA), has been a pharmacological mainstay in cardiac surgical patients. Despite its almost ubiquitous use, the temporal and regional modulation of PLact profiles by TXA remains unexplored. Accordingly, we developed a fluorogenic-microdialysis system to measure in vivo dynamic changes in PLact after TXA administration in a large animal model. ⋯ Using a large animal model and in vivo microdialysis measurements of PLact, the unique findings from this study were 2-fold. First, TXA induced temporally distinct PLact profiles within the plasma and selected interstitial compartments. Second, TXA caused region-specific changes in PLact profiles. These temporal and regional differences in the effects of TXA may have important therapeutic considerations when managing fibrinolysis in the perioperative period.
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Anesthesia and analgesia · Mar 2010
A novel classification instrument for intraoperative awareness events.
Intraoperative awareness with explicit recall occurs in approximately 1-2 cases per 1000. Given the rarity of the event, a better understanding of awareness and its sequelae will likely require the compilation of data from numerous studies. As such, a standard description and expression of awareness events would be of value. ⋯ We report a novel classification instrument for intraoperative awareness events that has excellent inter-observer agreement and that may facilitate the study of intraoperative awareness.
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Anesthesia and analgesia · Mar 2010
Optimizing the arrival, waiting, and NPO times of children on the day of pediatric endoscopy procedures.
Research in predictive variability of operating room (OR) times has been performed using data from multidisciplinary, tertiary hospitals with mostly adult patients. In this article, we discuss case-duration prediction for children receiving general anesthesia for endoscopy. We critique which of the several types of OR management decisions dependent on accuracy of prediction are relevant to series (lists) of brief pediatric anesthetics. ⋯ For brief pediatric OR anesthetics, predictive variability of case durations matters principally to the extent that it affects appropriate patient ready times. Such times should not be chosen by having patients start fasting, arrive, and be ready fixed numbers of hours before their scheduled start times.
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Anesthesia and analgesia · Mar 2010
Hemodynamic management and outcome of patients treated for cerebral vasospasm with intraarterial nicardipine and/or milrinone.
Vasospasm is a potentially devastating complication after aneurysmal subarachnoid hemorrhage. Although endovascular treatment with intraarterial nicardipine and milrinone is an accepted clinical treatment strategy, there is little information either on hemodynamic management during treatment or on outcome and consequences of the hemodynamic management. We tested 2 hypotheses: (1) intraarterial administration of nicardipine and milrinone to treat cerebral vasospasm would require increased administration of vasoconstrictor to support arterial blood pressure at target levels; and (2) high-dose vasopressors administered to increase blood pressure in these patients would lead to systemic acidosis and end-organ ischemic damage. ⋯ Intraarterial administration of nicardipine and/or milrinone requires use of vasopressors to maintain arterial blood pressure. Despite high doses of vasoconstrictors, treatment has low mortality, minimal end-organ ischemic damage or systemic acidosis, and results in improved caliber of cerebral vessels affected by vasospasm.
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Anesthesia and analgesia · Mar 2010
Case ReportsVentricular fibrillation during anesthesia in a Wenchuan earthquake victim with crush syndrome.
We cared for a victim of the Wenchuan earthquake who was rescued after being buried in rubble for 52 hours. On admission to the hospital, the patient had severe hyperkalemic acidosis and necrosis of both legs, requiring bilateral amputation. ⋯ The patient was resuscitated and recovered without significant systemic injury. We review the diagnosis and treatment of crush syndrome, which occurs in many victims of natural disasters.