Anaesthesia
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Review Meta Analysis Comparative Study
A meta-analysis of the accuracy and precision of the ultrasonic cardiac output monitor (USCOM).
The ultrasonic cardiac output monitor is a non-invasive, continuous-wave Doppler monitor that can be used to measure cardiac output. Its accuracy and precision in peri-operative and critical care has been assessed with varied results. ⋯ The mean weighted bias was -0.39 l.min(-1) (95% CI -0.25 to -0.53 l.min(-1) ), precision 1.27 l.min(-1) and percentage error 42.7% (95% CI 38.5-46.9%). The ultrasonic cardiac output monitor achieved similar agreement with bolus thermodilution to that of other minimally invasive methods of peri-operative cardiac output monitoring, and may have a useful role in cardiac output monitoring.
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We conducted a study to assess pharmacokinetics of high-dose tranexamic acid for 24 h after administration of the drug in patients undergoing cardiac surgery with cardiopulmonary bypass. High-dose tranexamic acid involved a bolus of 30 mg.kg(-1) infused over 15 min followed by a 16 mg.kg(-1) .h(-1) infusion until chest closure with a 2 mg.kg(-1) load within the pump prime. ⋯ Mean plasma tranexamic acid concentrations during the intra-operative period and in the first 6 postoperative hours were consistently higher than the suggested threshold to achieve 100% inhibition and 80% inhibition of tissue plasminogen activator. With recent studies implicating high-dose tranexamic acid as a possible aetiology of postoperative seizures following cardiac surgery, the minimum effective yet safe dose of tranexamic acid in high-risk cardiac surgery needs to be refined.