Masui. The Japanese journal of anesthesiology
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Variant conformity blood is often used in transfusion at massive unpredictable hemorrhage under an operation or at hemorrhagic shock in a lifesaving emergency arena. This is because of difficulty in performing blood grouping, because of difficulty in deciding blood types in the laboratory, or because of lack in store of the same blood type transfusion as a pharmaceutical preparation needed for the patients. In performing variant conformity transfusion in the hospital, it is vitally important that in-house system be well-organized and staff be thoroughly informed about variant conformity transfusion. This chapter explains system arrangements of organization for variant conformity transfusion in hospital settings based on our experience in the urgent use of O type RCC-LR (Red Cells Concentrates-Leukocytes Reduce, "Nisseki") pharmaceutical preparation.
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The present article reviewed the management of coagulopathy in the perioperative setting, following the Japanese practical guidelines for the blood component therapy, edited by the Ministry of Health, Labour and Welfare of Japan in 2005. The threshold concentrations of platelets, prothrombin time international normalized ratio (PT-INR) and activated partial thromboplastin time (APTT) were optimized for the perioperative critical care under active and/or microvascular bleeding, based on currently available randomized controlled trials. ⋯ Platelet counts, PT, APTT, and if possible, other point-of-care testing including thromboelastography and its modified techniques should be performed following visual inspection of abnormal bleeding. The transfusion algorithms based on causal diagnosis of coagulopathy optimize the risk/ benefit ratio of perioperative transfusion therapy.
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Randomized Controlled Trial Comparative Study
[Comparison of the Laryngeal Tube Suction and the Proseal laryngeal Mask Airway in anesthetized patients].
The Laryngeal Tube Suction (LTS : Smith Medical, Tokyo) is a new laryngeal tube that has an additional channel for gastric tube placement. Similarly, the Proseal Laryngeal Mask Airway (PLMA) also has a drain tube for gastric tube placement. This study compared the functions of these two devices. ⋯ With respect to clinical function, the LTS and PLMA were similar and either device can be used to establish an effective airway in anesthetized patients.
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Careful assessment of risks and benefits has to precede each decision on allogenic red blood cell (RBC) transfusion. Physicians work to establish more appropriate transfusions of blood components according to the guidelines issued by the Ministry of Health, Welfare, and Labor in Japan. For many years the so-called "10/ 30 rule" was used as a hemoglobin/hematocrit transfusion trigger. ⋯ Therefore, transfusion decisions should be primarily based on an individual patient's need for global and regional oxygen supply as indicated by signs of inadequate global and regional oxygenation. However, a hemoglobin transfusion trigger may be useful if matched with some other makers of inadequate tissue perfusion. Therefore, RBC transfusion is recommended under the following circumstances: for hemoglobin levels < 6 g x dl(-1) and for physiologic signs of inadequate oxygenation.
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The current efforts and strategies have greatly helped reduce transfusion-associated risks. Indeed, the risk of being infected by a contaminated blood unit today is lower than that thirty years ago. ⋯ Compatibility testing is designed to ensure that the patient receives the intended units of red cell concentrate (RCC) and that transfusion will be effective with minimum risk of adverse reactions. The process includes ABO and Rh typing of patients, testing recipient serum for clinically important alloantibodies, and crossmatching donor red cells with recipient serum by a technique that detects serological incompatibility.