Pub Date : 2017-06-01DOI: 10.1097/sa.0000000000000304
K. Mahomed, J. McLean, Muhtashim Ahmed, B. Zolotarev, N. Shaddock
This single-center, double-blind randomized controlled trial sought to assess whether intrauterine levobupivacaine reduced post hysteroscopy pain and need for analgesics and allowed earlier return to normal activity. During January 2013 to December 2015, 438 women were recruited into this study, with 224 in the intervention group and 214 in the control group. Levobupivacaine was chosen as the intrauterine anesthetic in the intervention group because of its safety profile. The control group received intrauterine normal saline
{"title":"Intrauterine Anaesthetic After Hysteroscopy to Reduce Post-operative Pain—A Double Blind Randomised Controlled Trial","authors":"K. Mahomed, J. McLean, Muhtashim Ahmed, B. Zolotarev, N. Shaddock","doi":"10.1097/sa.0000000000000304","DOIUrl":"https://doi.org/10.1097/sa.0000000000000304","url":null,"abstract":"This single-center, double-blind randomized controlled trial sought to assess whether intrauterine levobupivacaine reduced post hysteroscopy pain and need for analgesics and allowed earlier return to normal activity. During January 2013 to December 2015, 438 women were recruited into this study, with 224 in the intervention group and 214 in the control group. Levobupivacaine was chosen as the intrauterine anesthetic in the intervention group because of its safety profile. The control group received intrauterine normal saline","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87025800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1097/SA.0000000000000307
P. Dony, M. Dramaix, J. Boogaerts
The negative effects of hypocapnia are well documented, including a decrease in cerebral blood and cognitive function, an increase in airway resistance and pulmonary cellular dysfunction, vasoconstriction and an increase in myocardial oxygen demand, hypercoagulopathy, and dysrhythmias. However, there has been no study documenting an association between hypocapnia during anesthesia and postoperative mortality. The aim of this 8-month retrospective, observational study was to determine the impact of hypocapnia on inand out-of-hospital mortality in a diverse population of surgical patients within 30 days of surgery. The study’s secondary outcome was hospital length of stay (LOS), with particular attention to the proportion of patients with an LOS of more than 6 days. Complete case report forms of 5317 adult patients who underwent noncardiac surgery with general anesthesia were included in this study. Data collected included operation date, discharge date, and death date if appropriate.
{"title":"Hypocapnia Measured by End-Tidal Carbon Dioxide Tension During Anesthesia Is Associated With Increased 30-Day Mortality Rate","authors":"P. Dony, M. Dramaix, J. Boogaerts","doi":"10.1097/SA.0000000000000307","DOIUrl":"https://doi.org/10.1097/SA.0000000000000307","url":null,"abstract":"The negative effects of hypocapnia are well documented, including a decrease in cerebral blood and cognitive function, an increase in airway resistance and pulmonary cellular dysfunction, vasoconstriction and an increase in myocardial oxygen demand, hypercoagulopathy, and dysrhythmias. However, there has been no study documenting an association between hypocapnia during anesthesia and postoperative mortality. The aim of this 8-month retrospective, observational study was to determine the impact of hypocapnia on inand out-of-hospital mortality in a diverse population of surgical patients within 30 days of surgery. The study’s secondary outcome was hospital length of stay (LOS), with particular attention to the proportion of patients with an LOS of more than 6 days. Complete case report forms of 5317 adult patients who underwent noncardiac surgery with general anesthesia were included in this study. Data collected included operation date, discharge date, and death date if appropriate.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80253169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1097/01.sa.0000521855.52019.b9
José Lemos, G. Oliveira, H. E. D. P. Cardoso, L. Lemos, L. R. Carvalho, N. S. Módolo
{"title":"Gastric Regurgitation in Patients Undergoing Gynecological Laparoscopy With a Laryngeal Mask Airway: A Prospective Observational Study","authors":"José Lemos, G. Oliveira, H. E. D. P. Cardoso, L. Lemos, L. R. Carvalho, N. S. Módolo","doi":"10.1097/01.sa.0000521855.52019.b9","DOIUrl":"https://doi.org/10.1097/01.sa.0000521855.52019.b9","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73863764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1097/01.sa.0000521853.07171.c1
Michael D. Maile, W. Armstrong, E. Jewell, M. Engoren
The purpose of this single-center retrospective cohort study is to assess whether there is an increased risk of postoperative infection, respiratory, or kidney complications in patients undergoing noncardiac surgery who have decreased left ventricular systolic function. Participants were adults who underwent noncardiac surgery during the period January 1, 2005, to December 31, 2010, at the University of Michigan. Respiratory complication was defined as needing postoperative mechanical ventilation for over 48 hours or the occurrence of unplanned intubation. Kidney-related complications were defined as renal insufficiency with a postoperative increase in serum creatinine levels of more than 2 mg/dL or postoperative acute renal failure requiring dialysis. Infectious complications included pneumonia, urinary tract infections, sepsis, and wound infections. An independent association between decreased left ventricular ejection fraction (LVEF, a measure of systolic function) and renal and infectious complications were observed. A decreased LVEF correlated with a 69% increase in the odds of renal complications and a 33% increase in the odds of infectious complications. Amajor strength of this studywas the robustness of the comorbidities and outcomes collected as experienced cardiologists assessed LVEF, while trained experts collected patient and outcome data, unlike the hit-or-miss general administrative databases. Postoperative infections (n = 175 [10%]) were the most common postoperative complication in this study population of 1692 individuals, followed by respiratory complications, which manifested in 77 cases (5%), whereas renal complications occurred in 29 participants (2% of the study population). The time gap between the echocardiogram and surgery spanned from 7months (interquartile range, 1.8–15.7months) for thosewith severely reduced LVEF to 24 months (interquartile range, 2.5–38.6 months) for those with a normal LVEF (P = 0.038). A univariate statistical analysis supported a relationship between decreased preoperative LVEF and complications from infections and of the kidney but not respiratory complications. After adjusting for preoperative characteristics, decreased preoperative LVEF was associated with infectious complications (odds ratio, 1.33; 95% confidence interval, 1.03–1.68; P = 0.0265) and renal complications (odds ratio, 1.69; 95% confidence interval, 1.12–2.48; P = 0.0142). Thus, the findings of this study can help clinicians better balance the risks and benefits of various therapies as it emphasizes the noncardiac complications that can arise in patients with preexisting cardiac dysfunction undergoing noncardiac surgery. Published data exist on the association of increased major adverse cardiac events in patients with a known history of heart failure, but less is known on risk to other organ systems. The researchers from the University of Michigan have elucidated the effects of decreased LVEF in regard to infectious, renal, and res
{"title":"Impact of Ejection Fraction on Infectious, Renal, and Respiratory Morbidity for Patients Undergoing Noncardiac Surgery","authors":"Michael D. Maile, W. Armstrong, E. Jewell, M. Engoren","doi":"10.1097/01.sa.0000521853.07171.c1","DOIUrl":"https://doi.org/10.1097/01.sa.0000521853.07171.c1","url":null,"abstract":"The purpose of this single-center retrospective cohort study is to assess whether there is an increased risk of postoperative infection, respiratory, or kidney complications in patients undergoing noncardiac surgery who have decreased left ventricular systolic function. Participants were adults who underwent noncardiac surgery during the period January 1, 2005, to December 31, 2010, at the University of Michigan. Respiratory complication was defined as needing postoperative mechanical ventilation for over 48 hours or the occurrence of unplanned intubation. Kidney-related complications were defined as renal insufficiency with a postoperative increase in serum creatinine levels of more than 2 mg/dL or postoperative acute renal failure requiring dialysis. Infectious complications included pneumonia, urinary tract infections, sepsis, and wound infections. An independent association between decreased left ventricular ejection fraction (LVEF, a measure of systolic function) and renal and infectious complications were observed. A decreased LVEF correlated with a 69% increase in the odds of renal complications and a 33% increase in the odds of infectious complications. Amajor strength of this studywas the robustness of the comorbidities and outcomes collected as experienced cardiologists assessed LVEF, while trained experts collected patient and outcome data, unlike the hit-or-miss general administrative databases. Postoperative infections (n = 175 [10%]) were the most common postoperative complication in this study population of 1692 individuals, followed by respiratory complications, which manifested in 77 cases (5%), whereas renal complications occurred in 29 participants (2% of the study population). The time gap between the echocardiogram and surgery spanned from 7months (interquartile range, 1.8–15.7months) for thosewith severely reduced LVEF to 24 months (interquartile range, 2.5–38.6 months) for those with a normal LVEF (P = 0.038). A univariate statistical analysis supported a relationship between decreased preoperative LVEF and complications from infections and of the kidney but not respiratory complications. After adjusting for preoperative characteristics, decreased preoperative LVEF was associated with infectious complications (odds ratio, 1.33; 95% confidence interval, 1.03–1.68; P = 0.0265) and renal complications (odds ratio, 1.69; 95% confidence interval, 1.12–2.48; P = 0.0142). Thus, the findings of this study can help clinicians better balance the risks and benefits of various therapies as it emphasizes the noncardiac complications that can arise in patients with preexisting cardiac dysfunction undergoing noncardiac surgery. Published data exist on the association of increased major adverse cardiac events in patients with a known history of heart failure, but less is known on risk to other organ systems. The researchers from the University of Michigan have elucidated the effects of decreased LVEF in regard to infectious, renal, and res","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83223160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1097/01.sa.0000521732.87385.7f
Vikas Dutta, B. Kumar, A. Jayant, A. Mishra
OBJECTIVES To assess the effect of paravertebral administration of dexmedetomidine as an adjuvant to local anesthetic on the intraoperative anesthetic drug requirement and incidence of post-thoracotomy pain syndrome. DESIGN Prospective, randomized, controlled, double-blind trial. SETTING Single university hospital. PARTICIPANTS The study comprised 30 patients who underwent elective thoracotomy and were assigned randomly to either the Ropin or Dexem group (n = 15 each). INTERVENTIONS All patients received the study medications through paravertebral catheter. Patients in the Ropin group received a bolus of 15 mL of 0.75% ropivacaine over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine at 0.1 mL/kg/hour. Patients in the Dexem group received 15 mL of 0.75% ropivacaine plus dexmedetomidine, 1 µg/kg bolus over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine plus 0.2 µg/kg/hour of dexmedetomidine at 0.1 mL/kg/hour. MEASUREMENTS AND MAIN RESULTS The primary outcome of the study was intraoperative anesthetic drug requirement. The secondary outcome was the incidence of post-thoracotomy pain syndrome 2 months after surgery. The amount of propofol required for induction of anesthesia was significantly less in the Dexem group (Dexem 49.33±20.51 v 74.33±18.40 in the Ropin group, p = 0.002). End-tidal isoflurane needed to maintain target entropy was significantly less in the Dexem group at all time points. Intraoperative fentanyl requirement was lower in the Dexem group (Dexem 115.33±33.77 v 178.67±32.48 in the Ropin group, p = 0.002). Postoperative pain scores and morphine consumption were significantly less in the Dexem group (p<0.001). The incidence of post-thoracotomy pain syndrome was comparable between the 2 groups (69.23% v 50%, p = 0.496). CONCLUSIONS Paravertebral dexmedetomidine administration resulted in decreased intraoperative anesthetic drug requirement, less pain, and lower requirements of supplemental opioid in the postoperative period. However, it had no effect on the incidence of post-thoracotomy pain syndrome.
目的评价椎旁给药右美托咪定辅助局麻药对术中麻醉药物需求量和开胸术后疼痛综合征发生率的影响。前瞻性、随机、对照、双盲试验。单一大学医院。参与者:该研究包括30例接受择期开胸手术的患者，随机分为Ropin组和Dexem组(各15例)。干预措施所有患者均通过椎旁导管接受研究药物治疗。罗平组患者在3- 5分钟内注射15ml 0.75%罗哌卡因，然后以0.1 mL/kg/小时的速度输注0.2%罗哌卡因。右塞姆组患者接受15 mL 0.75%罗哌卡因加右美托咪定，1µg/kg, 3- 5分钟，随后以0.1 mL/kg/小时滴注0.2%罗哌卡因加0.2µg/kg/小时右美托咪定。研究的主要结果是术中麻醉药物的需要量。次要结果是术后2个月开胸后疼痛综合征的发生率。Dexem组诱导麻醉所需异丙酚用量明显低于Ropin组(Dexem 49.33±20.51 vs 74.33±18.40,p = 0.002)。在所有时间点，Dexem组维持目标熵所需的末潮异氟醚明显减少。Dexem组术中芬太尼需求量较低(Dexem为115.33±33.77 vs Ropin为178.67±32.48,p = 0.002)。Dexem组术后疼痛评分和吗啡用量显著低于对照组(p<0.001)。两组患者开胸后疼痛综合征发生率比较，差异有统计学意义(69.23% vs 50%， p = 0.496)。结论椎旁右美托咪定可减少术中麻醉药物的需用量，减轻疼痛，降低术后阿片类药物的需用量。然而，它对开胸术后疼痛综合征的发生率没有影响。
{"title":"Effect of Continuous Paravertebral Dexmedetomidine Administration on Intraoperative Anesthetic Drug Requirement and Post-Thoracotomy Pain Syndrome After Thoracotomy: A Randomized Controlled Trial.","authors":"Vikas Dutta, B. Kumar, A. Jayant, A. Mishra","doi":"10.1097/01.sa.0000521732.87385.7f","DOIUrl":"https://doi.org/10.1097/01.sa.0000521732.87385.7f","url":null,"abstract":"OBJECTIVES\u0000To assess the effect of paravertebral administration of dexmedetomidine as an adjuvant to local anesthetic on the intraoperative anesthetic drug requirement and incidence of post-thoracotomy pain syndrome.\u0000\u0000\u0000DESIGN\u0000Prospective, randomized, controlled, double-blind trial.\u0000\u0000\u0000SETTING\u0000Single university hospital.\u0000\u0000\u0000PARTICIPANTS\u0000The study comprised 30 patients who underwent elective thoracotomy and were assigned randomly to either the Ropin or Dexem group (n = 15 each).\u0000\u0000\u0000INTERVENTIONS\u0000All patients received the study medications through paravertebral catheter. Patients in the Ropin group received a bolus of 15 mL of 0.75% ropivacaine over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine at 0.1 mL/kg/hour. Patients in the Dexem group received 15 mL of 0.75% ropivacaine plus dexmedetomidine, 1 µg/kg bolus over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine plus 0.2 µg/kg/hour of dexmedetomidine at 0.1 mL/kg/hour.\u0000\u0000\u0000MEASUREMENTS AND MAIN RESULTS\u0000The primary outcome of the study was intraoperative anesthetic drug requirement. The secondary outcome was the incidence of post-thoracotomy pain syndrome 2 months after surgery. The amount of propofol required for induction of anesthesia was significantly less in the Dexem group (Dexem 49.33±20.51 v 74.33±18.40 in the Ropin group, p = 0.002). End-tidal isoflurane needed to maintain target entropy was significantly less in the Dexem group at all time points. Intraoperative fentanyl requirement was lower in the Dexem group (Dexem 115.33±33.77 v 178.67±32.48 in the Ropin group, p = 0.002). Postoperative pain scores and morphine consumption were significantly less in the Dexem group (p<0.001). The incidence of post-thoracotomy pain syndrome was comparable between the 2 groups (69.23% v 50%, p = 0.496).\u0000\u0000\u0000CONCLUSIONS\u0000Paravertebral dexmedetomidine administration resulted in decreased intraoperative anesthetic drug requirement, less pain, and lower requirements of supplemental opioid in the postoperative period. However, it had no effect on the incidence of post-thoracotomy pain syndrome.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85576674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1097/SA.0000000000000320
Ying-jie Geng, Qingyi Wu, Rui-qin Zhang
STUDY OBJECTIVE To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. DESIGN Prospective, randomized, double-blind clinical trial. SETTING University-affiliated teaching hospital. PATIENTS One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. INTERVENTIONS Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. MEASUREMENTS Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1-40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively. MAIN RESULTS The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P<0.001; propofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1-40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. CONCLUSIONS Propofol anesthesia may be an option for elderly surgical patients.
{"title":"Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial.","authors":"Ying-jie Geng, Qingyi Wu, Rui-qin Zhang","doi":"10.1097/SA.0000000000000320","DOIUrl":"https://doi.org/10.1097/SA.0000000000000320","url":null,"abstract":"STUDY OBJECTIVE\u0000To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population.\u0000\u0000\u0000DESIGN\u0000Prospective, randomized, double-blind clinical trial.\u0000\u0000\u0000SETTING\u0000University-affiliated teaching hospital.\u0000\u0000\u0000PATIENTS\u0000One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy.\u0000\u0000\u0000INTERVENTIONS\u0000Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia.\u0000\u0000\u0000MEASUREMENTS\u0000Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1-40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively.\u0000\u0000\u0000MAIN RESULTS\u0000The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P<0.001; propofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1-40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group.\u0000\u0000\u0000CONCLUSIONS\u0000Propofol anesthesia may be an option for elderly surgical patients.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72894951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1097/SA.0000000000000301
B. Schenk, A. K. Lindner, Benjamin Treichl, M. Bachler, M. Hermann, O. Larsen, C. Fenger-Eriksen, D. Wally, H. Tauber, C. Velik-Salchner, D. Fries
This study investigates how the use of fibrinogen concentrate ex vivo compares to the use of in vivo platelet transfusion (PT) to improve clot firmness in patients with thrombocytopenia (platelet count <150 10 L−1). While PT is currently first-line treatment to prevent bleeding in patients with clinically significant thrombocytopenia, PT carries significant risks, including viral or bacterial infection, febrile and nonfebrile transfusion reactions, and transfusion-related lung injury. Furthermore, the effectiveness of PT varies. The use of fibrinogen concentrate might be a useful tool to reduce PT, given its role in platelets activation and clot formation. Experimental data in animal models have indicated that fibrinogen concentrate can improve clot firmness better than PT. For this investigation, 100 patients aged between 18 and 35 years in need of PT were enrolled. Of the patients included, 88% were thrombocytopenic, and 65% had received antiplatelet medication. Indications for PTwere variable, but the most common indication was diffuse (microvascular) bleeding tendency. The enrolled patients’ blood samples were collected immediately before PT and 1 and 24 hours after PT. Using ROTEM (rotational thromboelastometry), the blood samples citrated with fibrinogen concentrate were analyzed at concentrations of 50, 100, 200, and 400mg kg−1 for the maximum clot firmness (MCF). ROTEM is a tool to predict, manage, and correct coagulation parameters. It was found that fibrinogen supplementation increasedMCF significantly and dose-dependently before and after PT. The effect of equivalent doses of 100 and 200 mg kg−1of fibrinogen concentrate ex vivo was comparable to that of PT in vivo. It was also noted that MCF improved markedly with 400 mg kg−1 compared with PT (P < 0.001). This study suggests that fibrinogen concentrate ex vivo compensates clot firmness to a similar degree as PT in vivo and could serve as an alternative treatment in appropriate situation. These results need to be confirmed in clinical trials.
本研究探讨了在血小板减少患者(血小板计数< 15010 L−1)中，体外使用浓缩纤维蛋白原与体内血小板输注(PT)如何改善凝块硬度。虽然PT目前是临床显著性血小板减少症患者预防出血的一线治疗方法，但PT具有显著的风险，包括病毒或细菌感染、发热性和非发热性输血反应以及输血相关肺损伤。此外，PT的有效性也各不相同。鉴于其在血小板活化和凝块形成中的作用，纤维蛋白原浓缩物的使用可能是降低PT的有用工具。动物模型实验数据表明，纤维蛋白原浓缩物比PT更能改善凝块硬度。本研究纳入了100例年龄在18 - 35岁之间需要PT治疗的患者。在纳入的患者中，88%的患者血小板减少，65%的患者接受了抗血小板药物治疗。ptr的适应症多种多样，但最常见的适应症是弥漫性(微血管)出血倾向。入组患者的血液样本在PT前立即采集，PT后1小时和24小时采集。使用ROTEM(旋转血栓弹性测定法)，用纤维蛋白原浓缩物在浓度为50、100、200和400mg kg−1时分析血液样本的最大凝块硬度(MCF)。ROTEM是一种预测、管理和纠正凝血参数的工具。结果发现，纤维蛋白原在PT前后显著增加mcf，且呈剂量依赖性。100和200 mg kg - 1纤维蛋白原浓缩物在体外的效果与PT在体内的效果相当。与PT相比，400 mg kg - 1组MCF明显改善(P < 0.001)。该研究表明，纤维蛋白原浓缩物在体外补偿凝块硬度的程度与体内PT相似，可以在适当的情况下作为替代治疗方法。这些结果需要在临床试验中得到证实。
{"title":"Fibrinogen Supplementation Ex Vivo Increases Clot Firmness Comparable to Platelet Transfusion in Thrombocytopenia","authors":"B. Schenk, A. K. Lindner, Benjamin Treichl, M. Bachler, M. Hermann, O. Larsen, C. Fenger-Eriksen, D. Wally, H. Tauber, C. Velik-Salchner, D. Fries","doi":"10.1097/SA.0000000000000301","DOIUrl":"https://doi.org/10.1097/SA.0000000000000301","url":null,"abstract":"This study investigates how the use of fibrinogen concentrate ex vivo compares to the use of in vivo platelet transfusion (PT) to improve clot firmness in patients with thrombocytopenia (platelet count <150 10 L−1). While PT is currently first-line treatment to prevent bleeding in patients with clinically significant thrombocytopenia, PT carries significant risks, including viral or bacterial infection, febrile and nonfebrile transfusion reactions, and transfusion-related lung injury. Furthermore, the effectiveness of PT varies. The use of fibrinogen concentrate might be a useful tool to reduce PT, given its role in platelets activation and clot formation. Experimental data in animal models have indicated that fibrinogen concentrate can improve clot firmness better than PT. For this investigation, 100 patients aged between 18 and 35 years in need of PT were enrolled. Of the patients included, 88% were thrombocytopenic, and 65% had received antiplatelet medication. Indications for PTwere variable, but the most common indication was diffuse (microvascular) bleeding tendency. The enrolled patients’ blood samples were collected immediately before PT and 1 and 24 hours after PT. Using ROTEM (rotational thromboelastometry), the blood samples citrated with fibrinogen concentrate were analyzed at concentrations of 50, 100, 200, and 400mg kg−1 for the maximum clot firmness (MCF). ROTEM is a tool to predict, manage, and correct coagulation parameters. It was found that fibrinogen supplementation increasedMCF significantly and dose-dependently before and after PT. The effect of equivalent doses of 100 and 200 mg kg−1of fibrinogen concentrate ex vivo was comparable to that of PT in vivo. It was also noted that MCF improved markedly with 400 mg kg−1 compared with PT (P < 0.001). This study suggests that fibrinogen concentrate ex vivo compensates clot firmness to a similar degree as PT in vivo and could serve as an alternative treatment in appropriate situation. These results need to be confirmed in clinical trials.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78456445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1097/01.sa.0000527587.95213.27
D. Warner, H. Sheng
Anesthesiology, V 126 • No 4 579 April 2017 A NESTHETICS possess num erous pharmacologic properties that could increase tolerance of brain to an ischemic insult. Despite investigation for over half a century,1 and robust demonstration of such benefit in laboratory animals,2 there is no solid evidence that anesthetic neuroprotection is present in humans.3 The article by Archer et al.4 in this issue of A nesthesiology provides considerable insight into this apparent paradox. It once seemed so straight forward. The brain consumes adenosine triphosphate at an incredible rate and holds little stores of this critical metabolite. Hence, continuous delivery of oxygen and glucose is essential to maintain adenosine triphosphate synthesis, neural function, and cellular integrity. Most anesthetics can markedly suppress metabolic rate. Thus, the duration the brain can survive in low-flow or no-flow states should be increased substantially. Neuroprotection investigation was focused on the perioperative environment for several decades. Anesthesiologists and surgeons were at the forefront of therapeutic stroke research. In the late 1980s, problems arose for the metabolic suppression hypothesis. Nonanesthetic drugs that had little or no effect on metabolic rate were found highly neuroprotective in the laboratory. Evidence rapidly grew in support of protective benefits from mild hypothermia, which again induced little change in metabolic rate. It was becoming clear that other neuroprotective mechanisms were important. And later, it became evident that exposure of brain to a mild stressor stimulus, either before (preconditioning) or after (postconditioning) a severe ischemic insult, set in play a biomolecular cascade that improved ischemic outcome. It is now known that anesthetics can also serve as effective conditioning stimuli, again independent of effects on metabolic rate during the ischemic insult. At the same time, a series of failures in detecting anesthetic neuroprotection in clinical trials accumulated, dashing almost all hope for such intervention. This caused a pivot of investigation away from neuroprotection in the perioperative environment toward development of nonanesthetic drugs relevant to the large number of patients who sustain out-of-hospital stroke. While the above logic sequence seems reasonable, is it all correct? The fact remains that after trials of scores of drugs in human stroke, other than tissue plasminogen activator, there is no pharmacologic intervention proven efficacious for any form of stroke in humans. This body of failure has led to serious questions regarding the pathway from bench to bedside for stroke drugs. Most such criticism has focused on the preclinical side of efficacy analysis. While major flaws in clinical trial designs must also be considered, lessons from the preclinical stroke research community are highly relevant to the study of anesthetics in the perioperative environment. Our m
麻醉学，V 126•No 4 579 April 2017麻醉学具有许多药理学特性，可以增加大脑对缺血性损伤的耐受性。尽管进行了半个多世纪的研究，并在实验动物身上有力地证明了这种益处，但并没有确凿的证据表明麻醉对神经有保护作用Archer等人在本期《A nesthesiology》上发表的文章对这个明显的悖论提供了相当深刻的见解。它曾经看起来是那么直截了当。大脑以令人难以置信的速度消耗三磷酸腺苷，并且很少储存这种关键的代谢物。因此，氧气和葡萄糖的持续输送对于维持三磷酸腺苷合成、神经功能和细胞完整性至关重要。大多数麻醉剂能显著抑制代谢率。因此，大脑在低流量或无流量状态下存活的时间应该大大增加。几十年来，神经保护的研究主要集中在围手术期环境。麻醉师和外科医生处于治疗性中风研究的前沿。20世纪80年代末，代谢抑制假说出现了问题。在实验室中发现，对代谢率影响很小或没有影响的非麻醉药物具有高度的神经保护作用。支持亚低温保护益处的证据迅速增加，亚低温也几乎没有引起代谢率的变化。越来越清楚的是，其他神经保护机制也很重要。后来，很明显，在严重的缺血损伤之前(预处理)或之后(后适应)，将大脑暴露于轻度应激刺激下，可以发挥生物分子级联作用，改善缺血结果。现在已知麻醉剂也可以作为有效的条件反射刺激，同样独立于对缺血性损伤期间代谢率的影响。与此同时，在临床试验中发现麻醉神经保护作用的一系列失败，使这种干预的希望几乎破灭。这使得研究重心从围手术期环境中的神经保护转向与大量院外中风患者相关的非麻醉药物的开发。虽然上述逻辑顺序似乎合理，但它都是正确的吗?事实仍然是，在对人类中风的数十种药物进行试验后，除了组织型纤溶酶原激活剂，没有任何药物干预被证明对任何形式的人类中风有效。这一系列的失败导致了关于中风药物从实验到临床的严重问题。此类批评大多集中在疗效分析的临床前方面。虽然临床试验设计中的主要缺陷也必须考虑在内，但临床前卒中研究界的经验教训与围手术期麻醉药的研究高度相关。我们从工作台到手术台的转换方法也应该重新考虑。这就是Archer等人的研究变得重要的地方。使用强大的搜索策略，我们确定了80个实验室研究，采用腔内细丝大脑中动脉闭塞模型5来研究麻醉对啮齿动物的神经保护作用。尽管与内源性或药理学溶栓引起的血流逐渐恢复相比，这种局灶性缺血模型因其接近瞬时血流恢复而受到批评，但该模型可能与麻醉神经保护特别相关。快速血流恢复发生在许多围手术期事件中(例如，脑动脉瘤或颈动脉手术期间的临时动脉闭塞)。此外，该模型被广泛应用，允许该搜索策略捕获大量研究。该模型已成为非麻醉神经保护药物研究的主力。因此，也可以从这一文学作品中找到相似之处。Archer等人4的分析结果令人惊讶。麻醉神经保护吗?这很复杂
{"title":"Anesthetic Neuroprotection? It's Complicated.","authors":"D. Warner, H. Sheng","doi":"10.1097/01.sa.0000527587.95213.27","DOIUrl":"https://doi.org/10.1097/01.sa.0000527587.95213.27","url":null,"abstract":"<zdoi;10.1097/ALN.0000000000001535> Anesthesiology, V 126 • No 4 579 April 2017 A NESTHETICS possess num erous pharmacologic properties that could increase tolerance of brain to an ischemic insult. Despite investigation for over half a century,1 and robust demonstration of such benefit in laboratory animals,2 there is no solid evidence that anesthetic neuroprotection is present in humans.3 The article by Archer et al.4 in this issue of A nesthesiology provides considerable insight into this apparent paradox. It once seemed so straight forward. The brain consumes adenosine triphosphate at an incredible rate and holds little stores of this critical metabolite. Hence, continuous delivery of oxygen and glucose is essential to maintain adenosine triphosphate synthesis, neural function, and cellular integrity. Most anesthetics can markedly suppress metabolic rate. Thus, the duration the brain can survive in low-flow or no-flow states should be increased substantially. Neuroprotection investigation was focused on the perioperative environment for several decades. Anesthesiologists and surgeons were at the forefront of therapeutic stroke research. In the late 1980s, problems arose for the metabolic suppression hypothesis. Nonanesthetic drugs that had little or no effect on metabolic rate were found highly neuroprotective in the laboratory. Evidence rapidly grew in support of protective benefits from mild hypothermia, which again induced little change in metabolic rate. It was becoming clear that other neuroprotective mechanisms were important. And later, it became evident that exposure of brain to a mild stressor stimulus, either before (preconditioning) or after (postconditioning) a severe ischemic insult, set in play a biomolecular cascade that improved ischemic outcome. It is now known that anesthetics can also serve as effective conditioning stimuli, again independent of effects on metabolic rate during the ischemic insult. At the same time, a series of failures in detecting anesthetic neuroprotection in clinical trials accumulated, dashing almost all hope for such intervention. This caused a pivot of investigation away from neuroprotection in the perioperative environment toward development of nonanesthetic drugs relevant to the large number of patients who sustain out-of-hospital stroke. While the above logic sequence seems reasonable, is it all correct? The fact remains that after trials of scores of drugs in human stroke, other than tissue plasminogen activator, there is no pharmacologic intervention proven efficacious for any form of stroke in humans. This body of failure has led to serious questions regarding the pathway from bench to bedside for stroke drugs. Most such criticism has focused on the preclinical side of efficacy analysis. While major flaws in clinical trial designs must also be considered, lessons from the preclinical stroke research community are highly relevant to the study of anesthetics in the perioperative environment. Our m","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90164843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1097/01.sa.0000516022.94902.80
Michael Hang Yang, M. Jaeger, M. Baxter, E. Vandenkerkhof, J. V. van Vlymen
PURPOSE Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c. METHODS This study included 257 non-diabetic adults scheduled for inpatient surgery. Preoperatively, capillary blood glucose (CBG) and HbA1c were measured and patients completed the Canadian Diabetes Risk Questionnaire (CANRISK). Capillary blood glucose was measured for two days or until hospital discharge at the following time points: postoperatively, before all meals, and at 22:00 hr. The mean CBG and incidence of hyperglycemia were compared between HbA1c levels: Group I < 6.0%, Group II 6.0-6.4%, and Group III ≥ 6.5%. RESULTS The mean postoperative glucose levels at all time points were significantly higher in Group III compared with Groups I and II (P < 0.01). At least one episode of hyperglycemia (CBG ≥ 10.0 mMol·L-1) occurred in 61% (11/18) of patients in Group III vs 11% (23/209) of patients in Group I (relative risk, 5.55; 95% confidence interval [CI], 3.26 to 9.47; P < 0.001). Elevated glycosylated hemoglobin ≥ 6.0% was found in 31% (33/107) of those with a high CANRISK score. The best predictors of postoperative hyperglycemia were preoperative CBG > 6.9 mMol·L-1 [diagnostic odds ratio (OR) (reference < 6.0 mMol·L-1), 4.16; 95% CI, 1.57 to 10.98; P = 0.004], HbA1c ≥ 6.0% [OR (reference < 6.0%), 3.00; 95% CI, 1.39 to 6.49; P = 0.005], and HbA1c ≥ 6.5% [OR (reference < 6.5%), 13.45; 95% CI, 4.78 to 37.84; P <0.001]. CONCLUSIONS Elevated HbA1c is associated with higher mean postoperative glucose levels in patients with no diabetic history. The CANRISK score is a strong predictor of elevated HbA1c, while CBG and HbA1c are both predictors of postoperative hyperglycemia.
{"title":"Postoperative dysglycemia in elective non-diabetic surgical patients: a prospective observational study.","authors":"Michael Hang Yang, M. Jaeger, M. Baxter, E. Vandenkerkhof, J. V. van Vlymen","doi":"10.1097/01.sa.0000516022.94902.80","DOIUrl":"https://doi.org/10.1097/01.sa.0000516022.94902.80","url":null,"abstract":"PURPOSE\u0000Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c.\u0000\u0000\u0000METHODS\u0000This study included 257 non-diabetic adults scheduled for inpatient surgery. Preoperatively, capillary blood glucose (CBG) and HbA1c were measured and patients completed the Canadian Diabetes Risk Questionnaire (CANRISK). Capillary blood glucose was measured for two days or until hospital discharge at the following time points: postoperatively, before all meals, and at 22:00 hr. The mean CBG and incidence of hyperglycemia were compared between HbA1c levels: Group I < 6.0%, Group II 6.0-6.4%, and Group III ≥ 6.5%.\u0000\u0000\u0000RESULTS\u0000The mean postoperative glucose levels at all time points were significantly higher in Group III compared with Groups I and II (P < 0.01). At least one episode of hyperglycemia (CBG ≥ 10.0 mMol·L-1) occurred in 61% (11/18) of patients in Group III vs 11% (23/209) of patients in Group I (relative risk, 5.55; 95% confidence interval [CI], 3.26 to 9.47; P < 0.001). Elevated glycosylated hemoglobin ≥ 6.0% was found in 31% (33/107) of those with a high CANRISK score. The best predictors of postoperative hyperglycemia were preoperative CBG > 6.9 mMol·L-1 [diagnostic odds ratio (OR) (reference < 6.0 mMol·L-1), 4.16; 95% CI, 1.57 to 10.98; P = 0.004], HbA1c ≥ 6.0% [OR (reference < 6.0%), 3.00; 95% CI, 1.39 to 6.49; P = 0.005], and HbA1c ≥ 6.5% [OR (reference < 6.5%), 13.45; 95% CI, 4.78 to 37.84; P <0.001].\u0000\u0000\u0000CONCLUSIONS\u0000Elevated HbA1c is associated with higher mean postoperative glucose levels in patients with no diabetic history. The CANRISK score is a strong predictor of elevated HbA1c, while CBG and HbA1c are both predictors of postoperative hyperglycemia.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88645625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1097/01.sa.0000515836.31290.fc
R. Freundlich, N. Duggal, Michelle T. Housey, Tyler T Tremper, M. Engoren, S. Kheterpal
Despite variations in definitions used, significant numbers of surgical cases are known to be complicated by anaphylaxis. This may be due to drugs such as antibiotics and neuromuscularblocking drugs or even due to latex and disinfectants. Poorly defined patient risk factors and difficulty in accurate and early identification of anaphylaxis by anesthesiologists increase the intraoperative risks. Epinephrine is a widely accepted first line of treatment, and intravenous fluids, antihistamines, and glucocorticoids offer the second line of treatment for anaphylaxis. Intraoperative anaphylaxis mortality is estimated at 0% to 1.4%. The main objective of the study was to identify drugs and patient factors related to hemodynamically significant anaphylaxis in adult patients undergoing surgery. Possible instances of hemodynamically significant anaphylaxis were studied from the University of Michigan Anesthesia Information Management System database from 2004 to 2015. The primary outcome was hemodynamically significant anaphylaxis: grade III (shock and/or life-threatening smooth muscle spasm) and grade IV (cardiac and/or respiratory arrest). The screening process used physiologic and treatment-based screening algorithm for identifying hypotension followed by treatment suggestive of anaphylaxis in “hemodynamically significant” adult (≥18 years old) patients. Two clinicians manually reviewed all the cases using predefined criteria, and a third clinician adjudicated any disagreements. Confirmed cases of hemodynamically significant anaphylaxis were matched 3:1 with control cases and were further reviewed to create a list of medications administered postanesthesia but before the onset of suspected anaphylactic reaction. Intraoperative medications administered in hemodynamically significant anaphylaxis cases and patient risk factors were compared with control cases. A total of 461,986 were studied; of these, 635 met the initial screening criteria, and of these, 55 cases (1 in 8400) were identified for likely hemodynamically significant anaphylaxis. It was noted that 52 patients experienced hemodynamically significant anaphylaxis (1 patient with 3 instances and 1 patient with 2 instances). Protamine was the only drug associated with an increased risk of hemodynamically significant anaphylaxis (odds ratio, 11.78; 95% confidence interval, 1.40–99.26; P = 0.0233) and that no other category of drugs was associated with an increased risk. Only personal history of anaphylaxis was associated with an increased risk (odds ratio, 77.1; 95% confidence interval, 10.46–567.69; P ≤ 0.0001). Other noted results were as follows: low postoperative follow-up and evaluation of patients; serum tryptase level was sent in only 49% of cases (41% positive vs
{"title":"Intraoperative Medications Associated With Hemodynamically Significant Anaphylaxis","authors":"R. Freundlich, N. Duggal, Michelle T. Housey, Tyler T Tremper, M. Engoren, S. Kheterpal","doi":"10.1097/01.sa.0000515836.31290.fc","DOIUrl":"https://doi.org/10.1097/01.sa.0000515836.31290.fc","url":null,"abstract":"Despite variations in definitions used, significant numbers of surgical cases are known to be complicated by anaphylaxis. This may be due to drugs such as antibiotics and neuromuscularblocking drugs or even due to latex and disinfectants. Poorly defined patient risk factors and difficulty in accurate and early identification of anaphylaxis by anesthesiologists increase the intraoperative risks. Epinephrine is a widely accepted first line of treatment, and intravenous fluids, antihistamines, and glucocorticoids offer the second line of treatment for anaphylaxis. Intraoperative anaphylaxis mortality is estimated at 0% to 1.4%. The main objective of the study was to identify drugs and patient factors related to hemodynamically significant anaphylaxis in adult patients undergoing surgery. Possible instances of hemodynamically significant anaphylaxis were studied from the University of Michigan Anesthesia Information Management System database from 2004 to 2015. The primary outcome was hemodynamically significant anaphylaxis: grade III (shock and/or life-threatening smooth muscle spasm) and grade IV (cardiac and/or respiratory arrest). The screening process used physiologic and treatment-based screening algorithm for identifying hypotension followed by treatment suggestive of anaphylaxis in “hemodynamically significant” adult (≥18 years old) patients. Two clinicians manually reviewed all the cases using predefined criteria, and a third clinician adjudicated any disagreements. Confirmed cases of hemodynamically significant anaphylaxis were matched 3:1 with control cases and were further reviewed to create a list of medications administered postanesthesia but before the onset of suspected anaphylactic reaction. Intraoperative medications administered in hemodynamically significant anaphylaxis cases and patient risk factors were compared with control cases. A total of 461,986 were studied; of these, 635 met the initial screening criteria, and of these, 55 cases (1 in 8400) were identified for likely hemodynamically significant anaphylaxis. It was noted that 52 patients experienced hemodynamically significant anaphylaxis (1 patient with 3 instances and 1 patient with 2 instances). Protamine was the only drug associated with an increased risk of hemodynamically significant anaphylaxis (odds ratio, 11.78; 95% confidence interval, 1.40–99.26; P = 0.0233) and that no other category of drugs was associated with an increased risk. Only personal history of anaphylaxis was associated with an increased risk (odds ratio, 77.1; 95% confidence interval, 10.46–567.69; P ≤ 0.0001). Other noted results were as follows: low postoperative follow-up and evaluation of patients; serum tryptase level was sent in only 49% of cases (41% positive vs","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80764936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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