Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2004
The impact of factor XIII on coagulation kinetics and clot strength determined by thrombelastography.
Fibrinogen has been shown to be responsible for most protein-mediated clot strength via thrombelastography. However, factor XIII (FXIII) activity also plays a prominent role in the development of clot strength. Thus, we hypothesized that changes in FXIII activity would significantly increase clot strength. ⋯ Finally, increases in FXIII activity significantly increased A and G in a sigmoidal pattern (R = 0.89; P < 0.001). We concluded that FXHI significantly affects R, alpha, A, and G. Thus, transfusion decision making with protein-mediated thrombelastographic patterns must account for the contribution of both fibrinogen and FXIII.
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Anesthesia and analgesia · Jul 2004
A new supraglottic airway, the Elisha Airway Device: a preliminary study.
We describe the Elisha Airway Device (EAD), a new reusable supraglottic ventilatory device. Its uniqueness consists of its ability to combine three functions in a single device: ventilation, blind and/or fiberoptic-aided intubation without interruption of ventilation, and gastric tube insertion. This study was performed in 70 ASA status I-II, Mallampati class I-II patients undergoing elective knee arthroscopy and receiving general anesthesia with mechanical ventilation. ⋯ Blind intubation was possible during the first and second attempts in 15 and 2 patients, respectively. Fiberoptic intubation was then successful in two of the remaining three patients. The EAD is a new alternative in the evolution of supraglottic ventilatory devices; however, further clinical studies are necessary to evaluate its efficacy.
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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
Arterio-jugular difference of oxygen content and outcome after head injury.
This study investigated AJDO2 (arterio-jugular difference of oxygen content) in a large sample of severely head-injured patients to identify its pattern during the first days after injury and to describe the relationship of AJDO2 with acute neurological severity and with outcome 6 mo after trauma. In 229 comatose head-injured patients, we monitored intracranial pressure, cerebral perfusion pressure, and AJDO2. Outcome was defined 6 mo after injury. ⋯ Cases with a favorable outcome had a higher mean AJDO2 (4.3 vol%; SD, 0.3 vol%) than patients with severe disability or vegetative status (3.8 vol%; SD, 1.3 vol%) and patients who died (3.6 vol%; SD, 1 vol%). This difference was significant (P < 0.001). We conclude that low levels of AJDO2 are correlated with a poor prognosis, whereas normal or high levels of AJDO2 are predictive of better results.
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Anesthesia and analgesia · Jul 2004
Case ReportsRecombinant factor VIIa for life-threatening bleeding in high-risk cardiac surgery despite full-dose aprotinin.
We report the case of an orthotopic heart transplant in a patient with multiple previous cardiac surgeries. The case was prolonged and complicated by severe coagulopathy and bleeding despite the use of full-dose aprotinin throughout. ⋯ There was no evidence of unwanted clot formation within the newly transplanted heart or around the intraaortic balloon pump that remained in situ for 72 h postoperatively. With the combined risks of coagulopathy and bleeding as well as acute right ventricular failure with increases in pulmonary vascular resistance, the re-do sternotomy for heart transplant seems to be an ideal situation in which to consider the use of recombinant factor VIIa.