Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2012
Randomized Controlled TrialTranexamic acid reduces blood loss after off-pump coronary surgery: a prospective, randomized, double-blind, placebo-controlled study.
Bleeding and the need for allogeneic transfusions are still problems after off-pump coronary artery bypass grafting (OPCAB) surgery. We therefore evaluated the effects of an antifibrinolytic, tranexamic acid, on postoperative bleeding and transfusion requirements in patients undergoing OPCAB surgery. ⋯ Tranexamic acid reduces postoperative chest tube drainage and the requirement for allogeneic transfusion in off-pump coronary surgery.
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Anesthesia and analgesia · Aug 2012
Measure to quantify the influence of time from end of surgery to tracheal extubation on operating room workflow.
The impact of delays in extubation on operating room (OR) workflow are challenging to assess because such delays may or may not be a bottleneck to the patient leaving the OR. We developed an observational measure that quantifies the influence of extubation times on OR workflow. ⋯ Longer times to extubation are associated with an increased chance of at least 1 person waiting in the OR. This measure can be used in observational studies and for lean engineering projects to assess conditions when time to extubation affects workflow. Observers can combine use of this measure for extubation times with the previously developed measure for studying the influence of induction times on OR workflow.
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Anesthesia and analgesia · Aug 2012
Antihypersensitivity effects of tramadol hydrochloride in a rat model of postoperative pain.
Tramadol is used to treat a wide range of acute and chronic pain. This drug induces analgesia by 2 mechanisms of action: opioid receptor activation and enhancement of noradrenaline (NA) and serotonin (5-HT) transmission. The effect of tramadol on NA and 5-HT concentrations in the spinal cord, however, have not been assessed. In the present study, we investigated the antihypersensitivity effect of tramadol using a rat model of postoperative pain. We also evaluated the increase in NA and 5-HT levels in the spinal cord after tramadol injection using in vivo microdialysis. ⋯ These findings indicate that tramadol inhibits postoperative hypersensitivity by increasing NA and 5-HT levels in the spinal cord and activating opioid receptors. Tramadol might be more effective in the early postoperative period when spinal NA and 5-HT levels are increased.
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Anesthesia and analgesia · Aug 2012
ReviewReview of the off-label use of recombinant activated factor VII in pediatric cardiac surgery patients.
In recent years the off-label use of recombinant activated factor VII (rFVIIa) has markedly increased, particularly in pediatric cardiac surgery patients, and practitioners differ widely in their usage of the drug. In 2009, the Congenital Cardiac Anesthesia Society (CCAS) assembled a task force to review the literature on rFVIIa administration to pediatric cardiac surgery patients. The goal of the CCAS Task Force was to assess current practices and make recommendations about rFVIIa therapy to enhance quality of care, improve patient outcomes, reduce costs, and develop future research. ⋯ There are insufficient data to make evidence-based recommendations. Randomized controlled trials are needed to assess the efficacy of rFVIIa as prophylactic, routine, or rescue therapy and to determine the drug's safety profile particularly with regard to thrombosis. The CCAS rFVIIa Task Force will continue to monitor the literature, gather data, and make updates as more information becomes available.