Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2009
ReviewCoagulopathy in trauma patients: importance of thrombocyte function?
Trauma-induced coagulopathy results from a complex interplay between shock resuscitation and impaired clotting protease function. A pathophysiological role of platelets in this condition remains as yet undefined. This review examines our current knowledge of platelet function in haemostasis, possible mechanisms for aberrant activity in trauma and the role of platelet transfusions in exsanguinating haemorrhage. ⋯ Platelets undoubtedly play a pivotal role in haemostasis and trauma-induced coagulopathy. However, their specific dysfunction in trauma remains to be elucidated. Further research to characterize the dysfunctional pathways of the platelet response is required, together with clinical trials of the optimal timing and dose of platelet transfusions.
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Curr Opin Anaesthesiol · Apr 2009
Time for changing coagulation management in trauma-related massive bleeding.
New insights into the pathophysiology of trauma-induced coagulopathy, the increasing availability of point-of-care devices and awareness of side effects of intravenous fluids and traditional fresh frozen plasma therapy has encouraged new concepts for managing massive blood loss. ⋯ During massive blood loss, viscoelastic measurements should guide aggressive treatment of deficiency or hyperfibrinolysis or both. In addition, the impact of contributing factors should be considered and as far as possible corrected. New data underscore the importance of avoiding hypoperfusion, and the use of coagulation factor concentrates should enable more effective correction of coagulopathy.
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Curr Opin Anaesthesiol · Apr 2009
ReviewImproving safety in the operating room: a systematic literature review of retained surgical sponges.
Gossypibomas are surgical sponges that are unintentionally left inside a patient during a surgical procedure. To improve this patient safety indicator, anesthesiologists will need to work with operating room personnel. This study's goal was to systematically review the literature on retained sponges to identify body location, time to discovery, methods for detection, and risk factors. ⋯ More is being discovered about the patterns leading to a retained sponge. Multidisciplinary approaches and new technologies may help reduce this low frequency but clinically significant event. However, given the complexity of surgical care, eliminating retained sponges may prove elusive.