Multicentre analysis of practice patterns regarding benzodiazepine use in cardiac surgery.

Background: There is controversy regarding optimal use of benzodiazepines during cardiac surgery, and it is unknown whether and to what extent there is variation in practice. We sought to describe benzodiazepine use and sources of variation during cardiac surgeries across patients, clinicians, and institutions.

Methods: We conducted an analysis of adult cardiac surgeries across a multicentre consortium of USA academic and private hospitals from 2014 to 2019.

Difficulty in Advancing Flexible Epidural Catheters When Establishing Labor Analgesia: An Observational Open-Label Randomized Trial.

Background: While flexible epidural catheters reduce the risk of paresthesia and intravascular cannulation, they may be more challenging to advance beyond the tip of a Tuohy needle. This may increase placement time, number of attempts, and possibly complications when establishing labor analgesia. This study investigated the ability to advance flexible epidural catheters through different epidural needles from 2 commonly used, commercially available, epidural kits.

Utilization Patterns of Perioperative Neuromuscular Blockade Reversal in the United States: A Retrospective Observational Study From the Multicenter Perioperative Outcomes Group.

Background: Following the introduction of sugammadex to the US clinical practice, scarce data are available to understand its utilization patterns. This study aimed to characterize patient, procedure, and provider factors associated with sugammadex administration in US patients.

Methods: This retrospective observational study was conducted across 24 Multicenter Perioperative Outcomes Group institutions in the United States with sugammadex on formulary at the time of the study.

Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis.

Background: Five percent of adult patients undergoing noncardiac inpatient surgery experience a major pulmonary complication. The authors hypothesized that the choice of neuromuscular blockade reversal (neostigmine vs. sugammadex) may be associated with a lower incidence of major pulmonary complications.

Promoting a Restrictive Intraoperative Transfusion Strategy: The Influence of a Transfusion Guideline and a Novel Software Tool.

Background: The effect of neither transfusion guidelines nor decision support tools on intraoperative transfusion has been previously evaluated. The University of Michigan introduced a transfusion guideline in 2009, and in 2011, the Department of Anesthesiology developed a transfusion decision support tool. The primary aim of this study was to assess the associations of the transfusion guideline and the optional use of the software transfusion tool with intraoperative behaviors; pretransfusion hematocrit assessment (whether or not a hematocrit was checked before each red cell unit) and restrictive red cell use (withholding transfusion unless the hematocrit was ≤21%).

Frequency of inadequate neuromuscular blockade during general anesthesia.

Study Objective: We used electronic health record data to define frequency of inadequate intraoperative neuromuscular blockade (NMB).

Design: Retrospective observational study using electronic health record data.

Setting: Operating room in a tertiary care academic hospital.

Observational study on patterns of neuromuscular blockade reversal.

Background: Using electronic health record data, we hypothesized that larger reversal doses are used for patients with deeper levels of neuromuscular blockade (NMB) as evidenced by the last recorded TOF measurement. We also examined if dosing regimens reflect current practice guidelines of using ideal body weight (IBW) for NMB agents and total body weight (TBW) for neostigmine.

Methods: This is a retrospective observational study of adult, ASA 1-4 patients who underwent general anaesthesia and received non-depolarizing NMB agents between 01/01/2004 and 12/31/2013.

Thrombotic Risks in Red Blood Cell Transfusions.

Red blood cells play a key role in normal hemostasis and thrombosis. Their ability to affect coagulation is multifactorial and depends on their mechanical properties affecting viscosity and blood flow, ability to aggregate and adhere to each other and potentially to vascular endothelium, molecular signaling via microvesicles and surface proteins, including blood group antigens, and participation in nitric oxide metabolism. Transfused red blood cells suffer from a storage lesion that damages the cells leading to changes in shape, function, and intracellular communication.

Perioperative management of bridge-to-lung transplant using ECMO.

Respiratory failure requiring intubation has traditionally been a relative contraindication to lung transplantation due to increased morbidity and mortality. Advances in extracorporeal membranous oxygenation (ECMO) have made it possible to extubate patients and provide physical therapy with minimal native lung function. By "bridging" patients to lung transplant using ECMO, they are able to undergo rehabilitation and withstand the demands of surgery.