Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 2015
Fibrinogen Measurements in Plasma and Whole Blood: A Performance Evaluation Study of the Dry-Hematology System.
An accurate and rapid determination of fibrinogen level is important during hemorrhage to establish a timely hemostatic intervention. The accuracy of fibrinogen measurements may be affected by the specific methodology for its determination, fluid therapies, and anticoagulant agents. The dry-hematology method (DRIHEMATO®) is a novel approach to determine fibrinogen levels in plasma and whole blood based on thrombin-activated coagulation time. We hypothesized that plasma or whole blood fibrinogen level using the dry-hematology method would be similar to those measured with conventional plasma fibrinogen assays. ⋯ This study demonstrated that fibrinogen levels can be accurately assessed by the dry-hematology method in plasma and the results are not affected by heparin or colloids. For whole blood fibrinogen measurements by dry-hematology, hematocrit adjustment is necessary to compensate for dynamic changes in hematocrit in perioperative bleeding settings.
-
Anesthesia and analgesia · Jan 2015
An electronic checklist improves transfer and retention of critical information at intraoperative handoff of care.
Communication failures are a significant cause of preventable medical errors, and poor-quality handoffs are associated with adverse events. We developed and implemented a simple checklist to improve communication during intraoperative transfer of patient care. ⋯ An electronic checklist improved relay and retention of critical patient information and clinician communication at intraoperative handoff of care.
-
Anesthesia and analgesia · Jan 2015
ReviewLaparoscopic surgery and muscle relaxants: is deep block helpful?
It has been hypothesized that providing deep neuromuscular block (a posttetanic count of 1 or more, but a train-of-four [TOF] count of zero) when compared with moderate block (TOF counts of 1-3) for laparoscopic surgery would allow for the use of lower inflation pressures while optimizing surgical space and enhancing patient safety. We conducted a literature search on 6 different medical databases using 3 search strategies in each database in an attempt to find data substantiating this proposition. In addition, we studied the reference lists of the articles retrieved in the search and of other relevant articles known to the authors. ⋯ First, monitoring of neuromuscular function is still essential and second, antagonism of deep block necessitates doses of sugammadex of ≥4.0 mg/kg. Thus, maintenance of deep block has substantial economic repercussions. There are little objective data to support the proposition that deep neuromuscular block (when compared with less intense block; TOF counts of 1-3) contributes to better patient outcome or improves surgical operating conditions.
-
Anesthesia and analgesia · Jan 2015
Multicenter Study Clinical TrialPsychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials.
Elective surgery can itself precipitate post-traumatic stress disorder even in the absence of intra-operative awareness.
pearl -
Anesthesia and analgesia · Jan 2015
Local Pathology and Systemic Serum Bupivacaine After Subcutaneous Delivery of Slow-Releasing Bupivacaine Microspheres.
Prolonged local anesthesia, particularly desirable to minimize acute and chronic postoperative pain, has been provided by microspheres that slowly release bupivacaine (MS-Bup). In this study, we report on the systemic drug concentrations and the local dermatopathology that occur after subcutaneous injection of MS-Bup. ⋯ Subcutaneous administration of microspheres releasing bupivacaine results in lower blood levels lasting for much longer times than those from bupivacaine solution.