Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Review
Alternatives to heparin and protamine anticoagulation for cardiopulmonary bypass in cardiac surgery.
Heparin anticoagulation followed by protamine reversal is commonly used in cardiopulmonary bypass (CPB) cardiac procedures, but this strategy has some limitations. The primary objective of this study was to determine the reliable alternatives for anticoagulation during CPB for cardiac surgery. For each drug proposed, the secondary objectives were to outline the main advantages and disadvantages, to propose a therapeutic protocol, and to provide a cost-benefit analysis. ⋯ The ideal anticoagulation strategy for cardiac surgery with CPB does not exist. Heparin and protamine remain the gold standard for anticoagulation therapy. To date, bivalirudin is the most promising molecule despite its high cost and lack of a readily available antagonist.
-
Randomized Controlled Trial
Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients.
Gabapentin was investigated as a single-dose adjunct to morphine for postoperative pain management. The primary objective was to determine if gabapentin given preoperatively and for two days postoperatively as part of multimodal analgesia would decrease postoperative morphine consumption in patients undergoing primary total hip arthroplasty (THA). ⋯ This trial indicated that gabapentin treatment had no clinically important reduction in postoperative morphine consumption at 72 hr in patients undergoing THA. Multimodal analgesia may account for the similar primary and secondary outcomes found in the groups. This trial was registered at ClinicalTrials.gov, number: NCT01307202.
-
Observational Study
The impact of advanced maternal age on peripartum thromboelastographic coagulation profiles: a prospective observational exploratory study.
Advanced maternal age (AMA) is a known risk factor for pregnancy-related venous thromboembolism. However, it is unclear if underlying differences exist in the maternal coagulation profiles of AMA vs non-AMA women. The aim of this prospective observational study was to compare peripartum thromboelastography parameters of AMA and non-AMA women undergoing elective Cesarean delivery (CD). ⋯ These data suggest that maternal thromboelastographic profiles of healthy AMA and non-AMA women undergoing elective CD are similar. The study was registered at ClinicalTrials.gov (identifier: NCT01416454).
-
Compared with other specialties, anesthesiologists are at increased risk of acquiring a blood-borne pathogen (BBP) through needle-stick injuries (NSIs). Safety-engineered intravenous catheters (SEICs) have been designed to reduce NSIs but have not been well received. Our objective was to determine SEIC usage by pediatric anesthesiologists, including availability, utilization, perceived utility, and sources of NSI before and after legislation mandating their use in Canada. ⋯ Despite only moderate perceived utility, SEIC uptake among CPAs is high. However, NSIs remain common. Several opportunities to reduce the risk for work-related BBP transmission among CPAs were evident.