Anesthesiology
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Randomized Controlled Trial Clinical Trial
Epsilon-aminocaproic acid in coronary artery bypass graft surgery: preincision or postheparin?
Epsilon-aminocaproic acid (epsilon-ACA), an antifibrinolytic agent, is used in cardiac surgery to decrease postoperative bleeding. Theoretical concerns exist about the potential for epsilon-ACA to contribute to thrombotic complications. For this reason epsilon-ACA administration is sometimes delayed until after heparinization. This study investigated the impact of the timing of epsilon-ACA administration on its efficacy. ⋯ Epsilon-ACA produces a reduction in chest tube drainage in patients undergoing primary coronary artery bypass graft surgery. This effect is similar whether the drug is given prior to incision or following anticoagulation. Given the similar hemostatic efficacy and the theoretical potential for thrombotic complications, it may be prudent to administer epsilon-ACA following anticoagulation.
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Numerous studies suggest setting positive end-expiratory pressure during conventional ventilation according to the static pressure-volume (P-V) curve, whereas data on how to adjust mean airway pressure (P(aw)) during high-frequency oscillatory ventilation (HFOV) are still scarce. The aims of the current study were to (1) examine the respiratory and hemodynamic effects of setting P(aw) during HFOV according to the static P-V curve, (2) assess the effect of increasing and decreasing P(aw) on slice volumes and aeration patterns at the lung apex and base using computed tomography, and (3) study the suitability of the P-V curve to set P(aw) by comparing computed tomography findings during HFOV with those obtained during recording of the static P-V curve at comparable pressures. ⋯ High-frequency oscillatory ventilation using P(aw) set according to a static P-V curve results in effective lung recruitment, and slice lung volumes during HFOV are equal to those from the deflation limb of the static P-V curve at equivalent pressures.
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The mechanisms responsible for initiation of persistent neuropathic pain after peripheral nerve injury are unclear. One hypothesis is that injury discharge and early ectopic discharges in injured nerves produce activity-dependent irreversible changes in the central nervous system. The aim of this study was to determine whether blockade of peripheral discharge by blocking nerve conduction before and 1 week after nerve injury could prevent the development and persistence of neuropathic pain-like behavior in the spared nerve injury model. ⋯ Peripheral long-term nerve blockade has no detectable effect on the development of allodynia or hyperalgesia in the spared nerve injury model. It is unlikely that injury discharge at the time of nerve damage or the early onset of ectopic discharges arising from the injury site contributes significantly to the persistence of stimulus-evoked neuropathic pain in this model.