Canadian journal of anaesthesia = Journal canadien d'anesthésie
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To review the pathophysiology of coagulopathy in massively transfused, adult and previously hemostatically competent patients in both elective surgical and trauma settings, and to recommend the most appropriate treatment strategies. ⋯ Coagulopathy associated with massive transfusion remains an important clinical problem. It is an intricate, multifactorial and multicellular event. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of hypothermia and anemia, and the use of hemostatic blood products to correct microvascular bleeding.
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Randomized Controlled Trial Comparative Study
Lower flange modification improves performance of the Macintosh, but not the Miller laryngoscope blade.
In order to minimize the potential for dental damage and to improve laryngeal visualization during tracheal intubation, two commonly used laryngoscope blades were modified and compared in a clinical setting: the Miller laryngoscope blade and the Macintosh laryngoscope blade. Modified versions of both laryngoscope blades with a lowered heel (Callander modification) at the proximal end of the blade were compared to standard blades. ⋯ A reduction of the proximal flange of a Miller blade decreases the blade's effectiveness for laryngeal visualization, whereas a similar modification of a Macintosh blade increases blade-tooth distance, decreases the number of blade-tooth contacts and provides a better laryngeal view.
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To summarize the physiology and pathophysiology relevant to perioperative blood loss in children. Strategies to reduce blood losses are reviewed. ⋯ Reducing perioperative allogenic blood transfusions is possible in pediatric patients provided that prophylactic measures are adapted to age, disease and type of surgery.
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Colloid solutions are widely used to prevent or to correct hypovolemia in surgical patients. Although more efficacious than crystalloids, they are more expensive and can be associated with adverse effects, in particular when they interfere with the hemostatic system. ⋯ In most cases, the clinical consequences of the biological effects of colloids on hemostasis are limited, provided that safety considerations are observed (maximum daily dosage, duration of treatment, patient's hemostatic status, clinical conditions). The implications may be different in patients with hemostatic disorders, either inherited or related to preoperative antiplatelet or anticoagulant treatment. In these patients, crystalloids, gelatins or even albumin solutions should be preferred when hemodilution exceeds 30% of the circulating blood volume.