Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Jun 2004
Review[Monitoring of heparin therapy during extracorporeal bypass: what are the remaining questions?].
Cardiac surgery with extracorporeal circulation induces major alterations of haemostasis and requires high level of anticoagulation, usually achieved by unfractionated heparin infusion. Optimization of anticoagulant regimen, through adapted biological monitoring, can probably improve postoperative course, at least for postoperative haemostatic status. Despite increasing knowledge on extracorporeal circulation-induced haemostatic abnormalities and the development of new biological devices for heparin monitoring, the optimal level of anticoagulation remains matter of debate, as well as the monitoring procedures. This critical review presents the current available data on heparin anticoagulation and monitoring in this specific context, and underlines the pending issues about anticoagulation management during extracorporeal bypass.
-
Ann Fr Anesth Reanim · Jun 2004
Clinical Trial[Postoperative nausea and vomiting: cost and therapeutic algorithm. Part II: high-risk patients and late PONV].
To evaluate in high-risk patients and in usual clinical conditions, the efficiency of treatments based on an algorithm on late (24 h) postoperative nausea and vomiting (PONV). ⋯ The use of a PONV therapeutic algorithm based on a scored risk was associated to a lower reduction of late PONV than already published in the literature while the cost was increased as expected. This suggests the efficacy of antiemetic prophylactic treatment might have been overestimated by large multicenter trials and is less in usual clinical conditions. Thus local evaluation of practice is required by performing quality insurance programs.