Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Cardiothoracic surgeons and anesthesiologists have had a long-standing interest in the proper use of transfusion therapy for their patients. ⋯ Issues such as the cost of blood, limited availability and the potentially harmful effects of transfusion dictate continued research and the development of methods to appropriately minimize transfusion to patients having cardiac surgery.
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We review the clinically important benefits of the two principal pharmacological strategies, erythropoietin (EPO) and antifibrinolytics (aprotinin and lysine analogues), to decrease transfusion of allogeneic blood products (ABP) during and after cardiac surgery. ⋯ We still need large scale studies to definitely confirm the benefits and exclude the deleterious effects of these drugs on outcomes other than ABP requirements. At present, aprotinin is the only agent that has been shown to reduce the risk of cerebrovascular accident and mortality after cardiac surgery in adults.
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Neuraxial blockade (spinal or epidural anesthesia) is still widely used in patients undergoing vascular surgery. However, the combined administration of anticoagulants and antiplatelet agents may compromise the safety of this technique with regards to the potential occurrence of a spinal or of an epidural hematoma. We review the benefits and risks of neuraxial blockade in light of the evolution of anticoagulation for vascular surgery. ⋯ Routine neuraxial blockade cannot be recommended in patients undergoing vascular surgery. The decision to perform a neuraxial block in such a patient may only be taken on a case by case basis, after careful consideration of expected benefits and potential risks.
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To assess the advantages of neuraxial blockade (NB) during and after vascular surgery and to confront them with the risk of epidural or spinal hematoma. ⋯ NB during vascular surgery is a safe and well-established practice. It offers many theoretical and demonstrated advantages. NB is particularly beneficial and economical for lower extremity vascular reconstruction. Still, NB may not be the best approach if the administration of fibrinolityc medication or prolonged heparin infusion is contemplated.
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To review the pharmacologic and pathophysiologic information necessary to prescribe beta-blockers (BB) in perioperative medicine. ⋯ BB have been shown to exert a beneficial effect on postoperative outcomes in patients with cardiovascular disease or risk factors, and their more widespread use in perioperative medicine is encouraged.