Anesthesiology
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Randomized Controlled Trial Clinical Trial
Randomized prospective comparison of forced air warming using hospital blankets versus commercial blankets in surgical patients.
The purpose of this study was to evaluate the efficacy of an experimental approach to forced air warming using hospital blankets or a Bair Hugger warming unit (Augustine Medical Inc., Eden Prairie, MN) to create a tent of warm air. ⋯ Standard hospital blankets heated to 38 degrees C forced air were equally as effective as commercial blankets heated with forced air at 43 degrees C. However, based on concerns expressed by the manufacturer, this experimental technique should not be used until further safety evaluation has been undertaken.
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Randomized Controlled Trial Clinical Trial
A neuroanatomical construct for the amnesic effects of propofol.
This study was designed to identify neuroanatomical locations of propofol's effects on episodic memory by producing minimal and maximal memory impairment during conscious sedation. Drug-related changes in regional cerebral blood flow (rCBF) were located in comparison with rCBF increases during a simple word memory task. ⋯ As amnesia becomes maximal, rCBF reductions induced by propofol occur in brain regions identified with working memory processes. In contrast, medial temporal lobe structures were resistant to the global CBF decrease associated with propofol sedation. The authors postulate that the episodic memory effect of propofol is produced by interference with distributed cortical processes necessary for normal memory function rather than specific effects on medial temporal lobe structures.
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Randomized Controlled Trial Clinical Trial
Pharmacokinetics of tranexamic acid during cardiopulmonary bypass.
Tranexamic acid (TA) reduces blood loss and blood transfusion during heart surgery with cardiopulmonary bypass (CPB). TA dosing has been empiric because only limited pharmacokinetic studies have been reported, and CPB effects have not been characterized. We hypothesized that many of the published TA dosing techniques would prove, with pharmacokinetic modeling and simulation, to yield unstable TA concentrations. ⋯ Tranexamic acid pharmacokinetics are influenced by CPB. Our TA pharmacokinetic model does not provide support for the wide range of TA dosing techniques that have been reported. Variation in TA efficacy from study to study and confusion about the optimal duration of TA treatment may be the result of dosing techniques that do not maintain stable, therapeutic TA concentrations.
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Randomized Controlled Trial Clinical Trial
Intraoperative low-volume acute normovolemic hemodilution in adult open-heart surgery.
Recently, various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding and the need for allogeneic transfusions in cardiac surgery. The aim of the present study was to reevaluate the effects of a low-volume ANH in elective, adult open-heart surgery. ⋯ In patients undergoing elective open-heart surgery, low-volume ANH showed lack of efficacy in reducing the need for allogeneic transfusions and postoperative bleeding.
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Randomized Controlled Trial Clinical Trial
Epidural blockade modifies perioperative glucose production without affecting protein catabolism.
Epidural blockade with local anesthetic has been shown to blunt the increase in plasma glucose concentration during and after abdominal surgery. The aim of the study was to test the hypothesis that epidural blockade inhibits this hyperglycemic response by attenuating endogenous glucose production. The authors further examined if the modification of glucose production by epidural blockade has an impact on perioperative protein catabolism. ⋯ Epidural blockade attenuates the hyperglycemic response to surgery through modification of glucose production. The perioperative suppression of protein metabolism was not influenced by epidural blockade.