Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2013
Computational analysis of the effects of reduced temperature on thrombin generation: the contributions of hypothermia to coagulopathy.
Hypothermia, which can result from tissue hypoperfusion, body exposure, and transfusion of cold resuscitation fluids, is a major factor contributing to coagulopathy of trauma and surgery. Despite considerable efforts, the mechanisms of hypothermia-induced blood coagulation impairment have not been fully understood. We introduce a kinetic modeling approach to investigate the effects of hypothermia on thrombin generation. ⋯ We developed a general computational strategy that can be used to simulate the effects of changing temperature on the kinetics of biochemical systems and applied this strategy to analyze the effects of hypothermia on thrombin generation. We found that thrombin generation can be noticeably impaired in subjects with different blood plasma composition even in moderate hypothermia. Our work provides mechanistic support to the notion that thrombin generation impairment may be a key factor in coagulopathy induced by hypothermia and complicated by blood plasma dilution.
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Anesthesia and analgesia · Sep 2013
Comparative StudyBrief report: a comparison of clinical and research practices in measuring cerebral perfusion pressure: a literature review and practitioner survey.
Our objective was to determine whether there is variability in the foundational literature and across centers in how mean arterial blood pressure is measured to calculate cerebral perfusion pressure. ⋯ There is substantive heterogeneity in both research reports and clinical practice in how mean arterial blood pressure is measured to determine cerebral perfusion pressure.
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Anesthesia and analgesia · Sep 2013
Case cancellation rates measured by surgical service differ whether based on the number of cases or the number of minutes cancelled.
Surgical cancellation rates typically are reported as the number of cancelled cases divided by the number of scheduled cases. However, the total number of cancelled minutes also has financial impact on surgeons' productivity. Cancellation rates can instead be calculated based on the number of minutes of cancelled cases. Hospitals typically benchmark cancellation rates, since not all cancellations are preventable (e.g., those due to new onset of patient symptoms requiring further workup and treatment before surgery can safely proceed). If the mean estimated duration of cancelled cases were the same as that of scheduled cases, rates would be equivalent whether calculated using the number of cancellations or the minutes of cancellations. It is unknown whether there is a difference between these 2 methods. ⋯ Calculating cancellation rates using case counts can inaccurately represent their impact on surgeon's productivity compared with using minutes of cancelled cases. Comparing numeric cancellation rates between hospitals or services without checking for bias may lead to inappropriate conclusions. We recommend that hospitals evaluate their data for potential bias to determine whether cancellation rates need to be calculated using scheduled minutes of cases rather than numbers of cancellations.
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Anesthesia and analgesia · Sep 2013
Stored platelet functionality is not decreased after warming with a fluid warmer.
Warming of IV-administered fluids and blood products is routinely performed in the operating room to help maintain normothermia. Current guidelines recommend against the warming of platelets (PLTs), although there is no evidence for this prohibition in the literature. Our goal in this pilot study was to determine whether the warming of stored PLTs had any effect on their function. ⋯ Although small in size, the results of this study do not support the prohibition against mechanical PLT warming. Studies of PLT activation after warming are also warranted.