Journal of clinical anesthesia
-
Comparative Study
The association of intraoperative neuraxial anesthesia on anticipated admission to the intensive care unit.
To determine whether use of intraoperative neuraxial anesthesia would decrease the frequency of ICU admission postoperatively in orthopedic patients. ⋯ Intraoperative neuraxial anesthesia in higher-risk patients undergoing elective hip or knee replacement surgery is associated with a decrease in anticipated ICU admission postoperatively. A causal relationship cannot be determined with this type of study and further research is needed to better understand this association.
-
To evaluate the effect of carbon dioxide (CO(2)) pneumoperitoneum and retropneumoperitoneum insufflation on CO(2) excretion. ⋯ This study may focus attention on the need for continuous ventilatory adjustments during transperitoneal endoscopic surgery.
-
Heparin-induced thrombocytopenia (HIT) is a common complication of heparin therapy. There are three types of HIT. In the majority of patients, thrombocytopenia is modest and resolves without sequelae (HIT I). ⋯ It is advisable that heparin not be administered in any form to patients with documented or suspected HIT II or HITT. This situation, of course, poses a problem for those patients requiring cardiopulmonary bypass (CPB) surgery. In this report, we summarize our experience with Lepirudin (Hoechst, Frankfurt Ammain, Germany), which is a recombinant hirudin (r-hirudin), as an alternative to heparin for systemic anticoagulation, as well as the use of the ecarine clotting time (ECT) for monitoring anticoagulation status during CPB.
-
Randomized Controlled Trial Clinical Trial
Late antinociception and lower untoward effects of concomitant intrathecal morphine and intravenous buprenorphine in humans.
To evaluate the perioperative antinociceptive effect of intrathecal morphine (a pure mu agonist), intravenous (IV) buprenorphine (a partial mu agonist) or their combination. ⋯ The concomitant administration of intrathecal morphine and IV buprenorphine alleviates pain sensation and minimizes sedation more effectively than when given after the administration of either drug separately. In addition, IV buprenorphine affords a reduction in side effects.
-
Clinical Trial Controlled Clinical Trial
Coagulation status using thromboelastography in patients receiving warfarin prophylaxis and epidural analgesia.
To determine the coagulation status of patients receiving postoperative warfarin and epidural analgesia using thromboelastography (TEG(R)). Prospective, observational, clinical study. Orthopedic postoperative division at a university hospital.52 ASA physical status II and III patients undergoing knee arthroplasty and receiving prophylactic warfarin and epidural analgesia. ⋯ There was no change in the coagulation index. However, INR was abnormal and significantly increased (INR = 1.48+/-0.3; p < 0.0001), compared with preoperative values, on the day when the epidural catheter was removed. When the epidural catheters are removed, overall coagulation status, as measured by TEG(R), and despite an elevated INR (mean INR <1.5), remained within normal limits in patients receiving low-dose warfarin prophylaxis.