Anesthesiology News
Assessment of the Effects of Desmopressin on Impaired Platelet Function Using Multiple Electrode Whole-Blood Aggregometry in Patients After Cardiac Surgery
Blood loss after cardiac surgery can be caused by acquired platelet dysfunction after cardiopulmonary bypass. Monitoring of platelet function is clinically important for the identification of patients experiencing such platelet dysfunction. 1-Deamino-8-d-arginine vasopressin (desmopressin acetate, DDAVP) has been shown to augment platelet function and to reduce blood loss in patients with platelet dysfunction. In this study, we examined the feasibility of whole blood multiple electrode aggregometry (MEA) for the detection of cardiopulmonary bypass–induced platelet dysfunction and investigated its ability to monitor DDAVP treatment. This study showed that Impaired platelet function after cardiac surgery can be assessed at the bedside using MEA. The effect of DDAVP on impaired platelet function can also be detected as significant improvement in platelet aggregation to all activators. This device might be helpful for the identification of patients who may benefit from DDAVP therapy.
Two Agents, One Syringe Provides Effective Anesthetic
A single syringe of remifentanil and propofol can deliver safe, effective IV anesthesia to patients undergoing ambulatory orthopedic surgery, a recent study has found.
The researchers, from the University of Utah, say their results may be hard for some clinicians to accept, given what they have been told to believe about total IV anesthesia (TIVA).
Plasmapheresis and Heparin Reexposure as a Management Strategy for Cardiac Surgical Patients with Heparin-Induced Thrombocytopenia
Anesthesia & Analgesia
A retrospective chart review between November 2004 and March 2008 retrieved perioperative clinical and laboratory data for 11 adult cardiac surgical patients with a preoperative history of HIT and a current positive antiheparin/platelet factor 4 (anti-HPF4) antibody titer, who were managed with plasmapheresis and heparin anticoagulation. Three of the 11 patients (27%) died of causes unrelated to HIT and 1 of these patients (9%) developed an ischemic foot, in the setting of cardiogenic shock, not thought to be HIT-related. A single plasmapheresis treatment reduced titers by 50%–84%, and 6 patients had negative titers after treatment; none of the 3 patients with reduced titers developed clinical HIT. Reducing antibody load can potentially decrease the thrombotic risk associated with high anti-HPF4 titers and decrease the urgency to initiate postoperative anticoagulation in this patient group at high risk of postoperative bleeding.
Protocol Designed for Rapid Response to Epidural Hematoma
The devastating neurologic complications that sometimes accompany epidural hematoma may be a thing of the past at Vanderbilt University Medical Center in Nashville, Tenn. Clinicians at the institution have implemented an expedited protocol for magnetic resonance imaging that involves several different medical specialties and significantly decreases the time from detection of neurologic symptoms to diagnosis.
Sugammadex reversal of rocuronium-induced NMB unaffected by volatile anesthetics
Sugammadex is equally effective for reversing rocuronium-induced neuromuscular blockade (NMB) in patients receiving maintenance anesthesia with sevoflurane or propofol, researchers report.
Analgesia for Total Hip and Knee Arthroplasty: A Review of Lumbar Plexus, Femoral, and Sciatic Nerve Blocks
Use of peripheral nerve blocks (PNBs) during lower extremity surgery has evolved. In this article, we review the pertinent anatomy and the literature concerning the advantages and disadvantages of both PNBs and traditional methods of postoperative analgesia (neuraxial and patient-controlled) for total hip arthroplasty and total knee arthroplasty.
Unilateral anesthesia possible with bupivacaine–clonidine combination
Unilateral spinal anesthesia can be achieved when bupivacaine is combined with clonidine, but clonidine does prolong the motor block and increase the need for vasopressors, researchers report. “Hyperbaric bupivacaine in small doses effectively produces unilateral spinal anesthesia for outpatient surgery,” Riika Merivirta (Turku University Hospital, Surgical Hospital, Finland) and colleagues point out.
A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study
An optimal target for glucose control in ICU patients remains unclear. This prospective randomized controlled trial compared the effects on ICU mortality of intensive insulin therapy (IIT) with an intermediate glucose control.
Continuous Renal Replacement Therapy (CRRT)
CRRT is a mode of renal replacement therapy for hemodynamically unstable, fluid overloaded patients and patients with sepsis and septic shock inmanagement of acute renal failure especially in the intensive careunit setting. The popularity of ‘slow continuous therapies’ for the treatment ofcritically ill patients with renal failure is increasing. The techniques which are most commonly used are slow continuous hemodialysis and hemodiafiltration.
