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https://www.readbyqxmd.com/read/28323673/clinical-pearls-of-maternal-critical-care-part-2-sickle-cell-disease-in-pregnancy
#1
Vinod Patil, Gamunu Ratnayake, Galina Fastovets
PURPOSE OF REVIEW: The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy. RECENT FINDINGS: Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined...
March 18, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28299184/revisiting-blood-transfusion-and-predictors-of-outcome-in-cardiac-surgery-patients-a-concise-perspective
#2
REVIEW
Carlos E Arias-Morales, Nicoleta Stoicea, Alicia A Gonzalez-Zacarias, Diana Slawski, Sujatha P Bhandary, Theodosios Saranteas, Eva Kaminiotis, Thomas J Papadimos
In the United States, cardiac surgery-related blood transfusion rates reached new highs in 2010, with 34% of patients receiving blood products. Patients undergoing both complex (coronary artery bypass grafting [CABG] plus valve repair or replacement) and non-complex (isolated CABG) cardiac surgeries are likely to have comorbidities such as anemia. Furthermore, the majority of patients undergoing isolated CABG have a history of myocardial infarction. These characteristics may increase the risk of complications and blood transfusion requirement...
2017: F1000Research
https://www.readbyqxmd.com/read/28274048/evaluation-of-cyclosporine-a-with-%C3%AE-tcp-in-the-treatment-of-human-infra-bony-defects-a-randomized-controlled-pilot-study
#3
Jyotsna Amalakara, Krishnajaneya Reddy, Haritha Avula, Ashank Mishra, Butchibabu Kalakonda, Ruchi Pandey
INTRODUCTION: Cyclosporine A (CsA), an immunosuppressant, is considered a life saver drug in organ transplant cases. It has also been tested in animal and human studies for periodontal applications as it selectively inhibits T lymphocyte proliferation, Interleukin-2 (IL-2) and other cytokine production, without any effect on T suppressor cells, thereby suppressing the cell mediated immunity and suppressing the inflammation. Inflammatory and immunological responses have been found to be decreased and bone formation is found to be increased in immunosuppressed animals...
January 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28144579/microvascular-response-to-transfusion-in-elective-spine-surgery
#4
J Matthias Walz, Ottokar Stundner, Federico P Girardi, Bruce A Barton, Aimee R Koll-Desrosiers, Stephen O Heard, Stavros G Memtsoudis
AIM: To investigate the microvascular (skeletal muscle tissue oxygenation; SmO2) response to transfusion in patients undergoing elective complex spine surgery. METHODS: After IRB approval and written informed consent, 20 patients aged 18 to 85 years of age undergoing > 3 level anterior and posterior spine fusion surgery were enrolled in the study. Patients were followed throughout the operative procedure, and for 12 h postoperatively. In addition to standard American Society of Anesthesiologists monitors, invasive measurements including central venous pressure, continual analysis of stroke volume (SV), cardiac output (CO), cardiac index (CI), and stroke volume variability (SVV) was performed...
January 18, 2017: World Journal of Orthopedics
https://www.readbyqxmd.com/read/28094033/vancomycin-added-to-the-wash-solution-of-the-cell-saver-effect-on-bacterial-contamination
#5
A Perez-Ferrer, E Gredilla-Díaz, J de Vicente-Sánchez, R Navarro-Suay, F Gilsanz-Rodríguez
OBJECTIVES: The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. MATERIAL AND METHOD: Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite(®) 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10μg/ml(-1) vancomycin (vanco group)...
April 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/27994257/changes-in-cerebral-oxygenation-during-transfusion-therapy
#6
Mumin Hakim, Dmitry Tumin, David P Martin, Walter Samora, Allan C Beebe, Jan E Klamar, Ashley B Hodge, Joseph D Tobias
This study assesses the effects of transfusion of autologous or allogeneic blood on cerebral and tissue oxygenation during spinal surgery. Packed red blood cell transfusions are indicated to improve oxygen delivery to tissues. There are limited data demonstrating changes in tissue oxygenation with blood administration. Tissue (deltoid) and cerebral oxygenation were monitored using near-infrared spectroscopy during spinal surgery in patients. As indicated, cell saver or allogeneic blood was administered. Tissue and cerebral oxygenation were recorded before and after transfusion...
December 2016: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/27850236/597-reinfusion-of-cell-saver-for-up-to-24-hours-post-collection-does-not-increase-risk-of-infection
#7
Elizabeth Nocera, L Eugene Daugherty, Ronald Angona, Hongyue Wang, Brena Tesini, George Alfieris, Jill Cholette
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27692949/does-moderate-hypothermia-really-carry-less-bleeding-risk-than-deep-hypothermia-for-circulatory-arrest-a-propensity-matched-comparison-in-hemiarch-replacement
#8
Jeffrey E Keenan, Hanghang Wang, Brian C Gulack, Asvin M Ganapathi, Nicholas D Andersen, Brian R Englum, Yamini Krishnamurthy, Jerrold H Levy, Ian J Welsby, G Chad Hughes
BACKGROUND: Moderate (MHCA) versus deep (DHCA) hypothermia for circulatory arrest in aortic arch surgery has been purported to reduce coagulopathy and bleeding complications, although there are limited data supporting this claim. This study aimed to compare bleeding-related events after aortic hemiarch replacement with MHCA versus DHCA. METHODS: Patients who underwent hemiarch replacement at a single institution from July 2005 to August 2014 were stratified into DHCA and MHCA groups (minimum systemic temperature ≤20°C and >20°C, respectively) and compared...
December 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27671218/anesthetic-management-of-transapical-off-pump-mitral-valve-repair-with-neochord-implantation
#9
Ali Sait Kavakli, Nilgun Kavrut Ozturk, Raif Umut Ayoglu, Mustafa Emmiler, Lutfi Ozyurek, Kerem Inanoglu, Sadik Ozmen
OBJECTIVES: Various minimally invasive surgical approaches have been used in mitral valve (MV) surgery. The transapical off-pump mitral valve intervention with NeoChord implantation (TOP-MINI) is a minimally invasive, alternative procedure for the treatment of degenerative mitral regurgitation. There are several special considerations for the anesthesiologist during the TOP-MINI procedure. The main purpose of this study was to present the anesthetic management of the TOP-MINI procedure...
December 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27591910/reinfusate-heparin-concentrations-produced-by-two-autotransfusion-systems
#10
Willem Frederik Buys, Mathilde Buys, Andrew Ian Levin
OBJECTIVES: Cell saver reinfusate ideally should contain low, clinically insignificant heparin concentrations. The American Association of Blood Banks has defined the clinically insignificant threshold as 0.5 IU/mL. Furthermore, there is uncertainty about the meaning of cell saver "heparin elimination rates." These concerns prompted the authors' independent investigation of reinfusate heparin concentrations of devices used in their institution. It was hypothesized that cell saver reinfusates contain clinically insignificant heparin concentrations...
June 15, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27575038/factors-that-predict-blood-loss-after-bernese-periacetabular-osteotomy
#11
Eduardo N Novais, Patrick M Carry, Lauryn A Kestel, Jason Koerner, Gee Mei Tan
Although strategies to reduce bleeding and avoid allogeneic transfusion have been described, there is controversy about the factors associated with blood loss after Bernese periacetabular osteotomy. This study was conducted to determine risk factors for postoperative blood loss. After institutional review board approval was obtained, a retrospective review was conducted of 41 young patients who underwent periacetabular osteotomy for symptomatic acetabular dysplasia over a 3-year period. Of these patients, two-thirds donated blood before surgery...
November 1, 2016: Orthopedics
https://www.readbyqxmd.com/read/27574548/living-donor-liver-transplantation-for-high-model-for-end-stage-liver-disease-score-what-have-we-learned
#12
Hany Dabbous, Mohammad Sakr, Sara Abdelhakam, Iman Montasser, Mohamed Bahaa, Hany Said, Mahmoud El-Meteini
AIM: To assess the impact of model for end-stage liver disease (MELD) score on patient survival and morbidity post living donor liver transplantation (LDLT). METHODS: A retrospective study was performed on 80 adult patients who had LDLT from 2011-2013. Nine patients were excluded and 71 patients were divided into two groups; Group 1 included 38 patients with a MELD score < 20, and Group 2 included 33 patients with a MELD score > 20. Comparison between both groups was done regarding operative time, intra-operative blood requirement, intensive care unit (ICU) and hospital stay, infection, and patient survival...
August 8, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/27557459/implementation-of-a-tranexamic-acid-protocol-to-reduce-blood-loss-during-cranial-vault-remodeling-for-craniosynostosis
#13
David T Martin, Heike Gries, Nick Esmonde, Brian Diggs, Jeffrey Koh, Nathan R Selden, Martin Schreiber, Anna A Kuang
OBJECTIVE: Pediatric cranial vault remodeling for repair of craniosynostosis is associated with significant blood loss and transfusion requirements. Beginning in 2011, the authors evaluated the impact tranexamic acid (TXA) on blood loss and blood product transfusion for children less than 15 months of age undergoing primary surgical repair of nonsyndromic single suture craniosynostosis. METHODS: Following institutional review board approval, the authors performed a retrospective study of all children undergoing surgical correction of craniosynostosis at Oregon Health & Science University from 2005 to 2015...
September 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27503696/infection-is-not-a-risk-factor-for-perioperative-and-postoperative-blood-loss-and-transfusion-in-revision-total-hip-arthroplasty
#14
Jaiben George, Matthew Sikora, Jessica Masch, Mario Farias-Kovac, Alison K Klika, Carlos A Higuera
BACKGROUND: Septic hip revisions are associated with greater complications and higher costs than aseptic revisions. It is unclear whether blood loss and transfusion requirements are different in septic and aseptic revisions. We hypothesized that the blood loss and transfusion are dependent on the complexity of the revision surgery and patient's general health rather than the presence of infection. METHODS: We retrospectively reviewed 626 revision total hip arthroplasties in 547 patients between 2009 and 2013...
January 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27450193/a-protocol-avoiding-allogeneic-transfusion-in-joint-arthroplasties
#15
You-Sung Suh, Jae-Hwi Nho, Hyung-Suk Choi, Yong-Chan Ha, Jong-Seok Park, Kyung-Hoi Koo
INTRODUCTION: Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Performing arthroplasties in Jehovah's Witness patients who do not accept transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Jehovah's Witness patients, and evaluated the feasibility and safety of the protocol. MATERIALS AND METHODS: The target of preoperative hemoglobin was more than 10 g/dL...
September 2016: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/27418211/argatroban-for-anticoagulation-of-a-blood-salvage-system-an-ex-vivo-study
#16
Martin Beiderlinden, Carsten Brau, Santo di Grazia, Michael Wehmeier, Tanja A Treschan
BACKGROUND: Blood salvage systems help to minimize intraoperative transfusion of allogenic blood. So far no data is available on the use of argatroban for anticoagulation of such systems. We conducted an ex-vivo trial to evaluate the effectiveness of three different argatroban doses as compared to heparin and to assess potential residual anticoagulant in the red cell concentrates. METHODS: With ethical approval and individual informed consent, blood of 23 patients with contraindications for use of blood salvage systems during surgery was processed by the Continuous-Auto-Transfusion-System (C...
2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27398896/indications-and-outcomes-of-cell-saver-in-adolescent-scoliosis-correction-surgery-a-systematic-review
#17
Nicholas Stone, Vandit Sardana, Paul Missiuna
STUDY DESIGN: Systematic review. OBJECTIVE: The aim of this study was to determine the indications and outcomes for intraoperative cell salvage during adolescent scoliosis correction surgery by systematically reviewing all available evidence. SUMMARY OF BACKGROUND DATA: Several blood conservation strategies exist to minimize the consequences of blood loss because of scoliosis correction surgery. The utility of intraoperative cell salvage has been contested in the literature with respect to benefits and cost...
March 15, 2017: Spine
https://www.readbyqxmd.com/read/27137133/cell-saver-processing-mitigates-the-negative-effects-of-wound-blood-on-platelet-function
#18
J Gäbel, C J Malm, V Radulovic, C Shams Hakimi, M Westerberg, A Jeppsson
BACKGROUND: Wound blood is highly activated and has poor haemostatic properties. Recent data suggest that retransfusion of unwashed wound blood may impair haemostasis. We hypothesized that cell saver processing of wound blood before retransfusion reduces the negative effects. METHODS: Wound blood was collected from 16 cardiac surgery patients during cardiopulmonary bypass. One portion of the wound blood was processed in a cell saver and one portion left unprocessed...
August 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27125086/effect-of-tranexamic-acid-use-on-postoperative-blood-loss-in-total-knee-arthroplasty
#19
Liliana Savin, Dan Mihăilescu, Carmen Grierosu, Paul Botez
AIM: To monitor the effect of tranexamic acid use (Exacyl) on postoperative bleeding (aspiration), autologous blood transfusion (autotransfusion), allogeneic blood transfusion and postoperative anemia (difference between preoperative and immediate postoperative hemoglobin levels) in total knee arthroplasty. MATERIALS AND METHODS: This retrospective observational study was conducted on a sample of 457 patients who underwent endoprosthetic knee arthroplasty in the interval January 1, 2008-July 3O, 2014 at the Traumatology-Orthopedics Clinic of the Iasi Rehabilitation Hospital...
January 2016: Revista Medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti Din Iaş̧i
https://www.readbyqxmd.com/read/27078879/infection-mediated-priming-of-phagocytes-protects-against-lethal-secondary-aspergillus-fumigatus-challenge
#20
Amélie Savers, Orhan Rasid, Marianna Parlato, Matthias Brock, Gregory Jouvion, Bernhard Ryffel, Jean-Marc Cavaillon, Gerard Eberl, Oumaïma Ibrahim-Granet
Phagocytes restrict the germination of Aspergillus fumigatus conidia and prevent the establishment of invasive pulmonary aspergillosis in immunecompetent mice. Here we report that immunecompetent mice recovering from a primary A. fumigatus challenge are protected against a secondary lethal challenge. Using RAGγc knock-out mice we show that this protection is independent of T, B and NK cells. In protected mice, lung phagocytes are recruited more rapidly and are more efficient in conidial phagocytosis and killing...
2016: PloS One
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