Multicenter Evaluation of the Quantra QPlus System in Adult Patients Undergoing Major Surgical Procedures.

Background: The management of perioperative bleeding and the optimization of the available therapies are subjects of significant clinical interest. Clinical guidelines recommend the use of whole blood viscoelastic testing devices to target the utilization of blood products during major surgical procedures. The Quantra QPlus System is a new cartridge-based viscoelastic testing device based on an innovative ultrasound technology.

Comparison of Coagulation Parameters in Arterial and Venous Blood in Cardiac Surgery Measured Using the Quantra System.

Objective: Perioperative coagulation testing often is performed with arterial samples even though device reference ranges typically are established in venous samples. Although limited studies exist comparing coagulation parameters across sampling sites, viscoelastic testing devices have demonstrated some differences. The objective of this study was to compare coagulation parameters determined using the Quantra System for venous and arterial samples.

Delayed Anaphylaxis to Mammalian Meat Following Tick Exposure and Its Impact on Anesthetic Management for Cardiac Surgery: A Case Report.

Hypersensitivity reactions to mammalian meat following tick exposure are increasing in prevalence and provide a unique challenge to anesthesiologists. The reactions, including anaphylaxis, are delayed and therefore may not be easily recognized and treated. The risk is especially high in cardiac surgery, where several potential triggers, including biological valves as well as heparin, are used frequently.

Comparison of SEER Sonorheometry With Rotational Thromboelastometry and Laboratory Parameters in Cardiac Surgery.

Background: The Quantra Hemostasis Analyzer is a novel diagnostic device that uses an ultrasound-based technology, sonic estimation of elasticity via resonance (SEER) sonorheometry, to characterize the dynamic changes in viscoelastic properties of a blood sample during coagulation. Cardiac surgery utilizing cardiopulmonary bypass (CPB) is associated with a significant impact on the coagulation system and can result in perioperative coagulopathy. The aim of this study was to correlate SEER sonorheometry results to corresponding rotational thromboelastometry (ROTEM) and laboratory parameters obtained before, during, and after CPB.

Pulmonary complications of cardiopulmonary bypass.

Pulmonary complications after the use of extracorporeal circulation are common, and they range from transient hypoxemia with altered gas exchange to acute respiratory distress syndrome (ARDS), with variable severity. Similar to other end-organ dysfunction after cardiac surgery with extracorporeal circulation, pulmonary complications are attributed to the inflammatory response, ischemia-reperfusion injury, and reactive oxygen species liberated as a result of cardiopulmonary bypass. Several factors common in cardiac surgery with extracorporeal circulation may worsen the risk of pulmonary complications including atelectasis, transfusion requirement, older age, heart failure, emergency surgery, and prolonged duration of bypass.

Evaluation of prenatal hydronephrosis: novel criteria for predicting vesicoureteral reflux on ultrasonography.

Purpose: Radiographic evaluation for prenatal hydronephrosis often includes voiding cystourethrography to ascertain whether vesicoureteral reflux is present. We sought to determine whether use of voiding cystourethrography could be limited to those patients at greatest risk for vesicoureteral reflux. We hypothesized that vesicoureteral reflux could be predicted by findings on renal/bladder ultrasonography of hydroureter, renal dysmorphia and/or duplication.

Repeated neurological complications during dialysis - a case for echo?

A 65-year old woman presented with acute or chronic renal failure and signs of right heart failure. Renal replacement therapy—using a surgically placed dialysis catheter via the left jugular vein—was repeatedly complicated by altered flows of the dialysis unit, impaired consciousness, new onset of seizures and left-sided hemiparesis. The tip of the dialysis catheter was detected on transesophageal echocardiography within the lumen of the ascending aorta.

Effects of early inhaled epoprostenol therapy on pulmonary artery pressure and blood loss during LVAD placement.

Objective: Several strategies have been used to reduce the incidence of right ventricular failure after left ventricular assist device (LVAD) placement, including pulmonary vasodilation. The inhaled prostacyclin, epoprostenol, selectively dilates the pulmonary vasculature of ventilated areas of the lung, but also has been shown to inhibit platelet aggregation.(1) The authors evaluated the impact of early initiation of epoprostenol administration during LVAD placement on pulmonary artery pressures, use of vasoactive drugs, and blood loss.

Local anesthetic-induced inhibition of human neutrophil priming: the influence of structure, lipophilicity, and charge.

Background And Objectives: Local anesthetics (LAs) are widely known for inhibition of voltage-gated sodium channels underlying their antiarrhythmic and antinociceptive effects. However, LAs have significant immunomodulatory properties and were shown to affect human neutrophil functions independent of sodium-channel blockade. Previous studies suggest a highly selective interaction between LAs and the α-subunit of G protein-coupled receptors of the Gq/G11 family as underlying mechanism.

Systemic lidocaine decreases the Bispectral Index in the presence of midazolam, but not its absence.

Study Objective: To evaluate the effects of intravenous (IV) lidocaine on the Bispectral Index (BIS) in the presence or absence of midazolam.

Design: Prospective, randomized, double-blinded, placebo-controlled clinical study.

Setting: Operating room of a university hospital.

HbA1c and diabetes predict perioperative hyperglycemia and glycemic variability in on-pump coronary artery bypass graft patients.

Objective: Perioperative hyperglycemia and glycemic variability are considered independent predictors of morbidity and mortality in critically ill patients. The purpose of this study was to investigate the relation of HbA1c and/or a prior diagnosis of diabetes mellitus and intra- and postoperative hyperglycemia and glycemic variability.

Design: A retrospective data analysis from a single-center database.

The effect of the intrathoracic pressure regulator on hemodynamics and cardiac output.

The intrathoracic pressure regulator (ITPR) (CirQLator; Advanced Circulatory Systems Inc, Roseville, Minn) is a novel, noninvasive device intended to increase cardiac output and blood pressure in hypovolemic or cardiogenic shock by generating a continuous low-level intrathoracic vacuum in between positive pressure ventilations. Although there are robust data supporting the benefit of the ITPR in multiple animal models of shock, the device has not been used in humans.The goals of this study were to evaluate both the safety and efficacy of the ITPR in humans.

Local anesthetic effects on human neutrophil priming and activation.

Background: The anti-inflammatory effects of local anesthetics (LAs) are well documented. Local anesthetics in micromolar concentrations inhibit extracellular oxygen release in isolated neutrophils; the underlying mechanism seems to be an inhibition of leukocyte priming. It remains unclear, however, if first, these effects also can be observed in whole blood, and second, if the priming of other neutrophil functions is similarly attenuated by LAs.

Systemic lidocaine decreased the perioperative opioid analgesic requirements but failed to reduce discharge time after ambulatory surgery.

Background: In this randomized, blinded, placebo-controlled trial, we evaluated whether systemic lidocaine would reduce pain and time to discharge in ambulatory surgery patients.

Methods: Sixty-seven patients were enrolled to receive lidocaine or saline infusion perioperatively.

Results: Length of postanesthesia care unit (PACU) stay did not differ between groups.

A brief review of innovative uses for local anesthetics.

Purpose Of Review: Local anesthetics are drugs which have many potentially beneficial actions, especially when used as a continuous intravenous infusion. The following review gives an update on the most recent literature along with some interesting and promising areas where systemic local anesthetics are being implemented.

Recent Findings: Surprisingly little research has been conducted with the use of systemic local anesthetics when considering their cost effectiveness, good side effect profile when used in low-dose infusions, and promising results in the available literature.

Tracheostomy in the critically ill: indications, timing and techniques.

Purpose Of Review: Tracheostomy is one of the most common procedures performed in the intensive care unit. Indications, risks, benefits, timing and technique of the procedure, however, remain controversial. The decision of when and how to perform a tracheostomy is often subjective, but must be individualized to the patient.

Antidepressants as local anesthetics: is there a place in regional anesthesia?

Purpose Of Review: Antidepressants have multiple sites of action. Among these, the ability to inhibit sodium channels has led to the increased interest in their use as local anesthetics. The following review summarizes the results of recent studies on this topic.