The Journal of surgical research
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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.
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Complement is invariably activated during trauma and contributes to tissue injury. Recombinant human decay-accelerating factor (DAF), a complement regulatory protein that inhibits both classical and alternative pathways, improves survival and reduces tissue damage in animal models of tissue injury. The extent to which DAF may facilitate resuscitation in hemorrhaged large animals is not known. ⋯ DAF improved survival and reduced early Hextend fluid resuscitation requirements in swine subjected to hemorrhagic shock. These benefits are attributed to decreased complement deposition and limited organ damage.
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Meta Analysis
The necessity of indwelling gastrointestinal decompression after gastrectomy: a meta-analysis.
This meta-analysis was designed to evaluate the necessity of indwelling gastrointestinal decompression after gastrectomy. ⋯ Routine gastrointestinal decompression after gastrectomy does not promote the recovery of gastrointestinal function or reduce the incidence of postoperative complications. In our series, decompression was correlated with a prolonged interval to oral intake, a longer duration of hospitalization, and increased patient discomfort.
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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.