The Journal of surgical research
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Hemorrhagic shock profoundly affects the neuroendocrine profile of trauma patients, and we hypothesized that massive resuscitation would negatively impact thyroid function. ⋯ Measurements of thyroid function are significantly altered in severely injured patients on initial presentation, and low T4 levels predict the need for large resuscitation. Further research investigating the profile and impact of thyroid function in trauma patients during resuscitation and recovery is warranted.
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Randomized Controlled Trial
Sevoflurane versus propofol anesthesia in patients undergoing lumbar spondylodesis: a randomized trial.
Spondylodesis is a procedure aiming at providing stability in one or more spinal segments. The aim of our study was to compare sevoflurane and propofol as induction and maintenance agents, focusing on hemodynamic stability, recovery characteristics, postoperative nausea and vomiting, and pain intensity. ⋯ Sevoflurane and propofol anesthesia for lumbar spondylodesis surgery provide safe and comparable results.
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Randomized Controlled Trial
Does dexmedetomidine affect intraoperative blood loss and clotting tests in pediatric adenotonsillectomy patients?
We hypothesize that dexmedetomidine (DEX), a selective α(2) adrenergic receptor agonist, may affect the intraoperative blood loss and clotting tests such as prothrombin time, activated partial thromboplastin time, and international normalized ratio in children undergoing adenotonsillectomy (ADT). ⋯ The premedication with DEX 0.5 μg/kg decreased postoperative agitation, pain, and analgesic requirement without significant change in the clotting tests and MAP but increased bleeding slightly during ADT.
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Comparative Study
Therapeutic mild hypothermia improves early outcomes in rabbits subjected to traumatic uncontrolled hemorrhagic shock.
Survival benefits of mild hypothermia in animals suffering from uncontrolled hemorrhagic shock (HS) may be influenced by trauma severity. We hypothesized that mild hypothermia would improve early outcomes based on our rabbit model of severe traumatic HS. ⋯ Therapeutic mild hypothermia improves early outcomes through improving lung and cardiac performance without causing evident homeostasis disturbances in the rabbit model of traumatic uncontrolled HS. Animals may benefit most under the combination treatment with mild hypothermia and limited fluid resuscitation.
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Intense debate continues in the search of the optimal ratio of blood components to deliver preemptively in the critically injured patient anticipated to require a massive transfusion. A major challenge is distinguishing patients with refractory coagulopathy versus those with overwhelming injuries who will perish irrespective of blood component administration. The hypothesis of this clinical study is that a predominant number of early deaths from hemorrhage are irretrievable despite an aggressive transfusion policy. ⋯ These data indicate that 75% of patients who succumb to postinjury acute blood loss are bleeding because they are dying rather than dying because they are bleeding. Conversely, only 13 (2%) of the hospital deaths were attributed to refractory coagulopathy. These critical facts need to be considered in designing studies to determine optimal massive transfusion protocols.