Anesthesia and analgesia
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Anesthesia and analgesia · May 2011
The association between thromboelastographic parameters and total estimated blood loss in patients undergoing elective cesarean delivery.
In this study, we assessed the relationship between coagulation parameters using kaolin-activated thromboelastography (TEG®) and total estimated blood loss (EBL) in patients undergoing elective cesarean delivery (CD). ⋯ There is a weak association between clot strength (as assessed by kaolin-activated TEG®) and EBL in patients undergoing elective CD under neuraxial anesthesia, and a modest reduction in the degree of maternal hypercoagulability occurs in the early postpartum period after elective CD.
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Anesthesia and analgesia · May 2011
Brief report: real-time ultrasound-guided spinal anesthesia using Taylor's approach.
The role of ultrasound scanning in spinal anesthesia is principally limited to preprocedure imaging and identification of anatomical structures. We describe our experience with a real-time ultrasound technique for visualization and performance of spinal anesthesia. ⋯ Subsequently, 10 patients scheduled for joint arthroplasty underwent real-time ultrasound-guided spinal anesthesia in the prone position. The relevant anatomy and the needletip were visualized easily and all spinals were effective for joint arthroplasty.
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Anesthesia and analgesia · May 2011
The safety of magnetic resonance imaging in patients with programmable implanted intrathecal drug delivery systems: a 3-year prospective study.
It is common clinical practice to perform magnetic resonance imaging (MRI) in patients with indwelling programmable intrathecal drug delivery (IDD) systems, although the safety of the procedure has never been documented. We performed a single-center, 3-year, prospective evaluation in patients with a programmable implanted IDD to assess patient discomfort, IDD technical failures, and adverse effects during and after exposure to MRI. ⋯ Performing an MRI scan with the proposed protocol in patients with an implanted Medtronic programmable IDD system resulted in virtually no technical or medical complications.
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Anesthesia and analgesia · May 2011
Differential roles of fibrinogen and von Willebrand factor on clot formation and platelet adhesion in reconstituted and immune thrombocytopenia.
Bleeding tendencies in immune thrombocytopenia (ITP) do not always correlate with the number of platelets, suggesting platelet function variation. We used a model of normal whole blood thrombocytopenia to compare platelet function and other hemostatic variables with ITP patients. We further investigated the effect of in vitro spiking with von Willebrand factor (vWF) and fibrinogen on platelet function and hemostatic variables. ⋯ Using a model of whole blood thrombocytopenia enables us to establish reference variables for the Cone and Plate(let) Analyzer and rotational thromboelastometry and to assess platelet function and clot formation in the presence of severe thrombocytopenia. We demonstrated that in most cases of ITP, platelet function is comparable to normal platelets. This work also suggests that vWF and fibrinogen differentially affect primary and secondary hemostasis and therefore both may perform a function in the bleeding phenotype and possibly may be considered for treatment in patients with ITP.