AANA journal
-
Comparative Study
Effects of Celox and TraumaDEX on hemorrhage control in a porcine model.
The purpose of this study was to compare the effectiveness of 2 hemostatic agents, chitosan-based Celox and the biopolymeric, microporous particles TraumaDEX, with a control group in a porcine model of hemorrhage. The animals were randomly assigned to 1 of 3 groups: Celox (n = 5), TraumaDEX (n = 5), or a standard pressure dressing alone (n = 5). To simulate a battlefield injury, the investigators generated a compound groin injury with transection of the femoral artery and vein in 15 pigs. ⋯ After 30 minutes, dressings were removed, and the amount of bleeding was measured. There were statistically significant differences in bleeding between Celox and control (P = .01) and between TraumaDEX and control (P = .038), but no statistically significant difference in bleeding between Celox and TraumaDEX (P = .478). Celox and TraumaDEX may be effective hemostatic agents for use in civilian and military trauma.
-
We report an unusual case of respiratory depression and prolonged apnea after a single, 50-mg intravenous dose of tramadol. Shortly after an uneventful surgery and anesthesia, the patient was administered intravenous tramadol. Soon after the tramadol injection, the patient became apneic, did not respond to verbal command, and started exhibiting oxygen desaturation. ⋯ The respiratory depression could be due to increased amount of (+)enantiomer in that ampoule of tramadol. Physiological parameters affecting the metabolism of either enantiomer of tramadol or perioperative drugs need to be evaluated, as do physiological changes affecting the activity or metabolism of (+enantiomer. This case report demonstrates that even a small single dose of tramadol administered intravenously in the immediate postoperative period after general anesthesia may manifest as sudden and prolonged apnea.
-
Dexmedetomidine (Precedex, Hospira, Lake Forest, Illinois), an alpha-2 agonist, mainly is used for sedating mechanically ventilated uncooperative patients in the intensive care setting. It also is being used by anesthesia providers for multiple purposes, including cardiothoracic surgeries, neurological surgeries, and awake-fiberoptic intubations and for patients with a high risk for airway obstruction. This article reports the investigation of the off-label use of dexmedetomidine as an anesthetic adjunct for a transsphenoidal pituitary tumor resection in an adult. The dexmedetomidine infusion not only provided the patient with added sedation but also decreased the need for narcotics and volatile agents while providing hemodynamic stability.
-
Local anesthetic toxicity can have catastrophic outcome in an otherwise benign procedure. Introduction of even a small amount of local anesthetic into the bloodstream can cause cardiac arrest in a healthy patient. Most healthcare facilities rely on standard resuscitative techniques to treat such events; however, treatment via infusion of lipid emulsion has been used successfully to stabilize the condition of some patients in a safe, effective, and rapid manner. ⋯ The key words included in the search were "Intralipid," "local anesthetic toxicity," "lipid infusion," and "lipid sink." Lipid therapy has shown great promise for the treatment of patients facing cardiovascular collapse due to local anesthetic toxicity. However, the slow adoption of this novel evidence-based practice by healthcare facilities endangers patients who may not receive the best available care when the need is most dire. Current evidence suggests that infusion of lipid emulsion should be considered among the primary treatments for local anesthetic toxicity and be made readily available in every facility's operating or procedure room, and hospital staff should be trained in its use when local anesthetic toxicity is suspected.