Journal of clinical anesthesia
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Clinical Trial Controlled Clinical Trial
Perioperative hypercoagulability in uremic patients: a viscoelastic study.
To examine whole blood coagulation in uremic patients presenting for surgery with the thromboelastogram and the Sonoclot analyzer. ⋯ The high incidence of arteriovenous graft and fistulae thromboses in uremic patients belies in vitro laboratory evidence of platelet dysfunction. We have demonstrated perioperative hypercoagulability in uremic patients with viscoelastic measures of whole blood coagulation. These data suggest that traditional concern for coagulopathy and platelet dysfunction in uremic patients may require re-assessment in light of this "pro-thrombotic" state.
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Anesthesia often involves the administration of several drugs belonging to different classes. In addition, many patients will be taking a number of drugs related to their surgical condition or for other medical diseases. ⋯ Other important interactions involve monoamine oxidase inhibitors, some antibiotics, and the tricyclic and tetracyclic antidepressants. These adverse interactions are the subject of this review.
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To determine if the ordering of unindicated preoperative laboratory tests is different for healthy (ASA physical status I and II) versus sicker (ASA physical status III) patients, and to examine the financial implications at our institution of unindicated preoperative testing. ⋯ A large percentage of preoperative tests ordered by surgeons at our institution are not indicated. Eliminating unindicated tests would cut hospital revenues in a climate where testing is fee-for-service and would save the hospital money in a managed-care or capitated system.
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Case Reports
Management of Jehovah's Witness patients for scoliosis surgery: the use of platelet and plasmapheresis.
Four patients whose religious beliefs prohibited accepting blood during surgery for scoliosis were anesthetized and managed successfully using plateletpheresis and plasmapheresis. Blood losses were replaced with crystalloid and hetastarch solutions. In addition, a moderate hypotensive technique was used to minimize surgical blood loss. ⋯ Three of these patients had an uncomplicated postoperative course, however, the fourth patient had some postoperative bleeding with initial hemodynamic instability. We believe that patients who refuse to receive blood transfusion during surgery because of religious beliefs or health issues can be managed safely using other alternatives and techniques such as plateletpheresis and plasmapheresis, which conserve and minimize blood loss. Each case should be assessed on an individual basis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ondansetron versus droperidol or placebo when given prophylactically for the prevention of postoperative nausea and vomiting in patients undergoing middle ear procedures.
To compare the prophylactic administration of ondansetron with droperidol or placebo to determine its effectiveness in reducing postoperative nausea and vomiting after middle ear procedures. ⋯ Ondansetron 4 mg i.v. is as effective as droperidol and better than placebo in preventing nausea and vomiting in patients undergoing middle ear surgery. No cost advantage as determined by lower use of rescue antiemetics or shorter PACU times was noted after the prophylactic administration of ondansetron.