Minerva anestesiologica
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Minerva anestesiologica · Aug 2014
ReviewIncreasing the number of lungs available for transplantation.
Lung transplantation has become a standard treatment for patients with a broad spectrum of end stage lung diseases. Despite this success, many patients die on the waiting list while waiting for appropriate lungs to become available. This review describes the current strategies aimed at addressing this shortage of lungs, as well as summarizing potential future directions in the field. They include efforts to: 1) increase the number of organ donors by legislative action, and education of the public; 2) optimize the management of deceased, potential organ donors; 3) implement optimal criteria to determine organs suitable for transplantation; 4) use ex vivo reconditioning of lungs; and 5) develop xenotransplantation.
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Minerva anestesiologica · Aug 2014
Comparative StudyHigh-dose fibrinogen versus a clinically recommended dose of fresh frozen plasma for reversal of dilutional coagulopathy in an in vitro model of severe hemodilution.
Volume substitution using colloids and crystalloids dose-dependently induces dilutional coagulopathy. For treatment, fibrinogen concentrate and fresh frozen plasma are options, though the effective dosage of either agent is unclear. The objective of this study was to evaluate, whether high-dose fibrinogen or recommended doses of fresh frozen plasma are equally effective in reversing profound dilutional coagulopathy in vitro. ⋯ High-dose fibrinogen concentrate and clinically recommended doses of fresh frozen plasma are equally effective and can partially restore viscoelastic coagulation assays in profound saline and gelatin dilutions, but only fresh frozen plasma improves conventional coagulation assays. Hydroxyethyl starch-induced disturbance of fibrin polymerization is neither restored by fibrinogen concentrate nor fresh frozen plasma.
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Several methods are reported in the literature to analyze medically undesirable events during hospital care. Each method has several limitations, so no one has been defined as the standard tool to be able to detect failure during a medical process. The aim of this study was to compare an anesthesiological perioperative checklist with traditional Regional Incident Reporting (RIR) form in detecting and describing failures. ⋯ An anesthesiological checklist compared with traditional RIR provided a more sensible and complete framework for incident analysis during the perioperative period in patients undergoing gynecological and obstetrical surgeries.