Acta anaesthesiologica Scandinavica
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Management of post-partum haemorrhage (PPH) involves the treatment of uterine atony, evacuation of retained placenta or placental fragments, surgery due to uterine or birth canal trauma, balloon tamponade, effective volume replacement and transfusion therapy, and occasionally, selective arterial embolization. This article aims at introducing pregnancy- and haemorrhage-induced changes in coagulation and fibrinolysis and their relevant compensatory mechanisms, volume replacement therapy, optimal transfusion of blood products, and coagulation factor concentrates, and briefly cell salvage, management of uterine atony, surgical interventions, and selective arterial embolization. Special attention, respective management, and follow-up are required in women with bleeding disorders, such as von Willebrand disease, carriers of haemophilia A or B, and rare coagulation factor deficiencies. We also provide a proposal for practical instructions in the treatment of PPH.
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Inappropriate withdrawal or continuation of medication in the perioperative period is associated with an increased risk for adverse events. To reduce this risk, it is important that patients take their regular medication as prescribed. We evaluated this treatment objective by studying the frequency and reasons for errors related to medication discontinuity in the perioperative period. ⋯ Medication errors occur frequently in the perioperative period, even in the era of an electronic medication file. Errors in prescription, administration and intake of medication are not easily solved because no single health care professional is responsible for adequate intake of medication in surgical patients. The anaesthesiologist should take on a more prominent role in regulating perioperative medication intake in surgical patients.
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Acta Anaesthesiol Scand · Nov 2010
Transfusion has no effect on recurrence in hepatitis C after liver transplantation.
The literature suggests that blood product transfusions have a negative impact on the survival of liver transplant patients. We investigated the impact of intraoperative blood product usage on the survival of liver transplantation patients being transplanted for hepatitis C-related end-stage liver disease. In addition, we analyzed a potentially more sensitive metric, namely disease recurrence and fibrosis progression, obtained from follow-up liver biopsies. ⋯ This study was not able to confirm an effect on the survival of HCV-infected liver transplant patients related to intraoperative transfusion of RBCs or platelets. In addition, these transfusions had no effect on HCV recurrence or fibrosis progression. This is not to condone a liberal transfusion practice, but rather to reassure that when clinically indicated, transfusion does not have a significant impact on patient survival or disease recurrence in HCV-infected liver transplant patients.
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Acta Anaesthesiol Scand · Nov 2010
Randomized Controlled TrialEffect of an intravenous infusion of lidocaine on cisatracurium-induced neuromuscular block duration: a randomized-controlled trial.
Intravenous lidocaine can be used intraoperatively for its analgesic and antihyperalgesic properties but local anaesthetics may also prolong the duration of action of neuromuscular blocking agents. We hypothesized that intravenous lidocaine would prolong the time to recovery of neuromuscular function after cisatracurium. ⋯ No significant prolongation of spontaneous recovery of a TOF ratio ≥ 0.9 after cisatracurium was found in patients receiving intravenous lidocaine.
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Acta Anaesthesiol Scand · Nov 2010
Randomized Controlled TrialThe effect of remifentanil on cough suppression after endoscopic sinus surgery: a randomized study.
Excessive coughing may increase the risk of complications after sinus surgery. We hypothesized that remifentanil would decrease the incidence and severity of coughing after endoscopic sinus surgery with propofol and remifentanil anaesthesia. ⋯ Maintaining anaesthesia with remifentanil to the end of the surgery, until after extubation, can suppress coughing without prolonging the recovery from anaesthesia. This effect is dose dependent and is more pronounced at higher concentrations of remifentanil (2.0 or 2.5 ng/ml).