Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 2009
Recombinant factor VIIa and fibrinogen display additive effect during in vitro haemodilution with crystalloids.
Major blood loss requires fluid resuscitation for maintaining hemodynamic stability. Excessive volume infusions predispose to dilutional coagulopathy through loss, consumption and dilution of cells and proteins involved in haemostasis. Further treatment with fibrinogen concentrate and/or recombinant activated factor VII (rFVIIa) may be initiated, although the haemostatic effects in a situation with haemodilution are not fully detailed. The present study evaluates haemostatic effect of fibrinogen and rFVIIa and their combination in an in vitro model of haemodiluted whole blood with two commonly used crystalloids. ⋯ The combination of fibrinogen and rFVIIa displays an additive effect and improves overall in vitro whole blood clot formation in a model of in vitro crystalloid-induced haemodilution.
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Acta Anaesthesiol Scand · Mar 2009
Clinical TrialProcedure-related pain among adult patients with hematologic malignancies.
Cancer patients undergo numerous invasive diagnostic procedures. However, there are only sparse data on the characteristics and determinants for procedure-related pain among adult cancer patients. ⋯ We found that 3/4 of hematologic patients who underwent BMA reported procedural pain; one third of these patients indicated severe pain. Pre-existing pain, anxiety about the diagnostic outcome of BMA or needle-insertion, and low employment status were independent risk factors.
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Acta Anaesthesiol Scand · Mar 2009
Equal effects of gelatin and hydroxyethyl starch (6% HES 130/0.42) on modified thrombelastography in children.
Artificial colloids are frequently used to prevent or treat circulatory failure due to hypovolaemia. Whereas gelatin has been shown not to affect coagulation besides its haemodilutional effect, hydroxyethyl starches (HES) have additional negative effects on haemostasis. The third-generation HES solutions have been developed to minimise these effects. We therefore conducted a prospective, randomised study, to verify the hypothesis that a 6% HES 130/0.42/6 : 1 and a 4% gelatin infusion influences modified thrombelastography (TEM) parameters in children in the same manner and to the same extent. ⋯ In conclusion, we could demonstrate that the investigational product, HES 130/0.42/6 : 1 solution, administered at a dosage of 10 ml/kg to children, had comparable effects on coagulation monitored with TEM as a gelatin solution. Perioperative administration of HES 130/0.42/6 : 1 does not alter coagulation to an extent above and beyond the effect of haemodilution.
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Acta Anaesthesiol Scand · Mar 2009
Randomized Controlled Trial Comparative StudyComparison of closed loop vs. manual administration of propofol using the Bispectral index in cardiac surgery.
In recent years, electroencephalographic indices of anaesthetic depth have facilitated automated anaesthesia delivery systems. Such closed-loop control of anaesthesia has been described in various surgical settings in ASA I-II patients (1-4), but not in open heart surgery characterized by haemodynamic instability and higher risk of intra-operative awareness. Therefore, a newly developed closed-loop anaesthesia delivery system (CLADS) to regulate propofol infusion by the Bispectral index (BIS) was compared with manual control during open heart surgery. ⋯ The automated delivery of propofol using CLADS was safe, efficient and performed better than manual administration in open heart surgery.