Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2019
Association of Neuraxial Anesthesia With Postoperative Venous Thromboembolism After Noncardiac Surgery: A Propensity-Matched Analysis of ACS-NSQIP Database.
Neuraxial anesthesia improves components of the Virchow's triad (hypercoagulability, venous stasis, and endothelial injury) which are key pathogenic contributors to venous thrombosis in surgical patients. However, whether neuraxial anesthesia reduces the incidence of venous thromboembolism (VTE) remain unclear. We therefore tested the primary hypothesis that neuraxial anesthesia reduces the incidence of 30-day VTE in adults recovering from orthopedic surgery. Secondarily, we tested the hypotheses that neuraxial anesthesia reduces 30-day readmission, 30-day mortality, and the duration of postoperative hospitalization. ⋯ Neuraxial anesthesia appears to provide only weak VTE prophylaxis, but can be offered as an adjuvant to current thromboprophylaxis in high-risk patients.
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Anesthesia and analgesia · Mar 2019
Comparative StudyUse of Earlier-Reported Rotational Thromboelastometry Parameters to Evaluate Clotting Status, Fibrinogen, and Platelet Activities in Postpartum Hemorrhage Compared to Surgery and Intensive Care Patients.
Rotational thromboelastometry (ROTEM) can provide clinical information in 10-20 minutes for guiding administration of fibrinogen, platelets, and fresh frozen plasma products. While ROTEM testing is well established for cardiac and other surgeries, it is less characterized for use in postpartum hemorrhage (PPH) patients. We wanted to determine if the earlier-measured ROTEM parameters (α-angle and amplitude at 10 minutes [A10]) could replace the later parameters (amplitude at 20 minutes and maximum amplitude [maximum clot firmness {MCF}]) in all patient groups studied. We also correlated the A10 and α-angle of the EXTEM and FIBTEM tests to the fibrinogen levels and platelet counts in these patients. ⋯ The correlations among the ROTEM parameters for the PPH comparisons were equivalent to the C/T OR patients studied, and the A10EX and A10FIB could replace the MCF results in all patient groups. Also, the α-EX was an early indicator of the A10EX and had good correlations to the A10FIB and the fibrinogen in all patient groups. Finally, in a separate group of 62 comparisons, the FIBTEM α angle showed promise as an early indicator of the A10FIB and the fibrinogen levels.
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Anesthesia and analgesia · Mar 2019
Ketamine as a Rapid Sequence Induction Agent in the Trauma Population: A Systematic Review.
The choice of drug used to facilitate endotracheal intubation in trauma patients during rapid sequence induction (RSI) may have an impact on survival. Ketamine is commonly used in the hemodynamically unstable trauma patient although it has been associated with side effects. This review sought to investigate whether ketamine should be preferred over other induction agents for RSI in trauma patients. ⋯ No significant differences were observed (OR, 1.14 [0.87-1.49] and OR, 1.1 [0.95-1.27], respectively). Extremely few studies have compared induction agents for RSI in trauma patients. No significant differences have been found in mortality, length of hospital stay, or number of blood transfusions after induction with ketamine compared to other induction agents, but a clinically relevant benefit or harm cannot be excluded.
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Anesthesia and analgesia · Mar 2019
Does the Incidence of Postoperative Complications After Inguinal Hernia Repair Justify Hospital Admission in Prematurely and Term Born Infants?
Postoperatively, young infants are admitted overnight in view of the risk for respiratory complications such as desaturation and apnea. This risk seems much lower than previously reported. Until what age this risk persists, and which infants might actually qualify for day-care treatment, is unknown. ⋯ Incidence of postoperative respiratory complications is high in preterm infants <45 weeks PCA requiring postoperative overnight saturation and heart rate monitoring. Incidence of postoperative complications in preterm born infants 45-60 weeks PCA varies. Gestational age and possibly presence of respiratory history can be used to estimate the need for overnight admission in these infants. Postoperative respiratory complications after inguinal hernia repair in ASA physical status I and II term born infants >1 month of age are uncommon, which justifies day-care admission for this type of surgical procedure.