British journal of anaesthesia
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Comparative Study
Comparison of thromboelastometry (ROTEM®) with standard plasmatic coagulation testing in paediatric surgery.
Thromboelastometry (ROTEM(®)) might be useful to detect intraoperative coagulation disorders early in major paediatric surgery. This observational trial compares this technique to standard coagulation tests. ⋯ PT and aPTT cannot be interchangeably used with ROTEM(®) CT. Based on the results of ROTEM(®), recommended thresholds for PT and aPTT might overestimate the need for coagulation therapy. A good correlation was found between the fibrinogen level and the FibTEM assay. In addition, ROTEM(®) offered faster turnaround times.
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The main factor limiting organ donation is the availability of suitable donors and organs. Currently, most transplants follow multiple organ retrieval from heartbeating brain-dead organ donors. However, brain death is often associated with marked physiological instability, which, if not managed, can lead to deterioration in organ function before retrieval. ⋯ Despite increasing consensus over donor management protocols, many of their components have not yet been subjected to controlled evaluation. Hence the optimal combinations of treatment goals, monitoring, and specific therapies have not yet been fully defined. More research into the component techniques is needed.
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'Cardiomyopathy' (CM) is defined by the World Health Organization as 'a disease of the myocardium associated with cardiac dysfunction'. In a child, it is associated with a significant risk for anaesthesia. In addition, cardiac arrest under anaesthesia has been attributed to an undiagnosed CM. ⋯ This review describes the different forms of the disease in terms of pathology, aetiology, and clinical presentation. Dilated, hypertrophic, and restrictive CM are the most common forms. We examine recent advances in therapy, including the management of severe end-stage disease, while highlighting the specific anaesthetic considerations for children with each type of CM.
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Deceased donation in the UK relies upon family consent. Approaching a family at the tragic time of a loved one's death requires significant emotional resilience from staff. ⋯ This paper seeks to provide an overview of some of key issues relating to death, death rituals, faith, and how these may impact upon organ donation. This should be of benefit to staff dealing closely with recently bereaved families and who will be requesting organ donation from them.
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Laws and policies governing the use of organs for transplantation are evolving rapidly in response to sensitivity to ethical concerns and increasing shortages of transplantable organs. They are necessarily becoming increasingly detailed and complex. Professional practice will be enhanced by clear statements of current provisions, and the debates accompanying their formulation and evolution. This is necessarily a highly selective contribution, with focus on what are perceived to be the most critical items affecting contemporary deceased donation, apart from the meaning of death itself.