Anesthesia and analgesia
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Life-threatening anaphylaxis or febrile nonhemolytic transfusion reactions after transfusion of platelet concentrates (PCs) is a serious clinical problem caused by the sensitizing of recipients to plasma components, such as immunoglobulin A, or by cytokines. There is a possible indication for washing of PCs in these thrombocytopenic patients. However, only platelets that show activation after physiological stimulation are useful. ⋯ Because of increased spontaneous activation after washing we could demonstrate cytometrically a loss of induced activation of washed platelets. Furthermore, washing resulted in an impaired ADP-induced aggregability of platelets. These results have led us to reduce the frequency of washing of PCs in our institution, where the only current indication for washing of PCs is in patients with a history of severe nonhemolytic transfusion reactions.
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Anesthesia and analgesia · Jul 2004
Does the presence of a tracheal bronchus affect the margin of safety of double-lumen tube placement?
During double-lumen tube (DLT) placement, the anesthesiologist must be mindful of the margin of safety. We determined how this margin is affected by the presence of a tracheal bronchus by elucidating the mathematical relationship between some relevant physical dimensions of the trachea, bronchi, and DLT. Our results suggest that a tracheal bronchus only rarely affects the intrinsic margin of safety of DLT placement. When the tracheal bronchus is located much higher than its most frequently seen location (within 2 cm from the carina), however, there is increased risk that it could be blocked by the tracheal cuff of a left-sided DLT.
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Anesthesia and analgesia · Jul 2004
Intrathecal catheterization and solvents interfere with cortical somatosensory evoked potentials used in assessing nociception in awake rats.
We assessed the objective measurement of central sensitization processes in the awake rat after subcutaneous formalin with cortical somatosensory evoked potentials (CSEPs). Cranial extradural electrodes and intrathecal catheters were implanted in adult male Wistar rats. After 7 days of recovery, CSEPs were induced by electrical stimuli at the tail and recorded before/after the injection of 50 microL of 2% formalin into the hindpaw of rats for 1 h. ⋯ We found that the amplitudes of both signals increased (154.3% +/- 10.9% and 168.7% +/- 9.8%, respectively) from 10 min after formalin injection to the end of the 60-min test period. Pretreatment with intrathecal ketorolac dose-dependently prevented the increases induced by formalin in both measured variables. Moreover, the increases in P1-N1 and N2 were markedly attenuated either by intrathecal polyethylene-10 tubing or by the solvents used for injection, thus indicating the need for distinguishing an impaired nociceptive signal from antinociception when the effects of drugs are evaluated.
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Anesthesia and analgesia · Jul 2004
Case ReportsMucositis and airway obstruction in a pediatric patient.
Pediatric patients undergoing induction regimens of chemotherapy may require intubation and mechanical ventilation either for respiratory failure or airway compromise as a complication of their therapy. We describe a case of difficult airway management resulting from pseudomembrane formation in a 16-yr-old girl. The patient was undergoing induction chemotherapy for stage IV rhabdomyosarcoma and developed severe mucositis that led to progressive airway obstruction.
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Anesthesia and analgesia · Jul 2004
Case ReportsAn unusual cause of left ventricular outflow tract obstruction after mitral valve repair.
Left ventricular outflow tract (LVOT) obstruction caused by systolic anterior motion is a cause of failed mitral valve repair. Intraoperative transesophageal echocardiography has been very helpful in diagnosing problems with mitral valve repairs intraoperatively, allowing immediate correction. We report an unusual cause of LVOT obstruction attributed to prolapse of the annuloplasty ring into the LVOT. Intraoperative hemodynamics were normal, and the diagnosis would not have been made before leaving the operative suite without the transesophageal echocardiography.