European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Mar 1997
ReviewDesmopressin--a haemostatic drug: state-of-the-art review.
Desmopressin is a well tolerated and convenient haemostatic drug that can be used in a number of clinical conditions with bleeding diathesis. It has several effects on the haemostatic system, causing endogenous release of coagulation factor VIII, von Willebrand factor, tissue plasminogen activator and also increasing platelet adhesiveness and shortening bleeding time. The effect is virtually immediate and lasts for several hours. ⋯ The optimal dosage is 0.3 microgram kg-1 intravenously, but the drug may also be administered subcutaneously or intranasally. In addition to the established indications, haemophilia A, von Willebrand's disease and platelet dysfunction, the drug may also be used safely in other patients with unexpected bleeding during or after surgery. The effectiveness of general prophylactic use of desmopressin, in order to diminish surgical blood loss and transfusion requirements, has not been proven, except in patients with known bleeding diathesis caused by congenital or acquired haemostatic disorders, e.g. in those taking aspirin.
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Peri-operative bleeding is associated with invasive surgery and has traditionally been compensated for by blood transfusion. Concerns about the risk of transfusion-transmitted disease have led to an increasing interest in synthetic haemostatic agents. ⋯ Clinical trials using desmopressin in open cardiac surgery indicate that it may reduce blood loss in those with an excessive bleeding tendency. However, it is difficult to identify this group pre-operatively.
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Eur J Anaesthesiol Suppl · Mar 1997
ReviewReview of clinical experience of desmopressin in patients with congenital and acquired bleeding disorders.
This paper discusses clinical experience of the use of desmopressin in patients with either congenital or acquired bleeding disorders. The bleeding disorders reviewed herein are haemophilia A, von Willebrand's disease and platelet function disorders (congenital bleeding disorders); uraemia, liver cirrhosis and drug-induced bleeding (acquired bleeding disorders).
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Target-controlled infusion (TCI) systems have dramatically simplified the technique of total intravenous infusion. Systems have been used successfully to provide patient sedation during a variety of surgical procedures. ⋯ Using the analgesic alfentanil, good quality post-operative analgesia can be achieved without under- or overdosing. The recent development of using effector-site drug concentrations as a guide to the extent of sedation should allow fine control of patient sedation with TCI systems.
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Eur J Anaesthesiol Suppl · Jul 1996
Sedation during regional anaesthesia: indications, advantages and methods.
Patient management is a vital component of regional anaesthesia, and the appropriate method and level of sedation must be chosen for each patient on an individual basis. This may range from simple distraction through pharmacologically induced anxiolysis or hypnosis, to light general anaesthesia by the inhalational or intravenous routes. ⋯ Currently, midazolam and propofol are considered to be the most suitable drugs. Patient safety must never be compromised and pharmacological sedation must be administered by a trained practitioner, with appropriate patient monitoring and provision of supplementary oxygen.