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Magic in a bottle? A Focused review of factor concentrates for the intraoperative treatment of acquired coagulopathy - Fibrinogen concentrate, prothrombin complex concentrate, and recombinant activated factor VII.
Best Pract Res Clin Anaesthesiol
December 2023
Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Goal-directed administration of blood components including red cells, platelets, plasma, and factor concentrates plays a critical role in the management of intraoperative coagulopathy. Increasingly commonly used, purified and recombinant factor concentrates are being recognized for their logistical advantages and potentially superior efficacy. Three- and four-factor prothrombin concentrates, fibrinogen concentrates and activated factor VII have an evolving evidence base relative to frozen plasma and cryoprecipitate.
View Article and Find Full Text PDFPostoperative anaemia: Hiding in plain sight.
Best Pract Res Clin Anaesthesiol
December 2023
Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Minnesota, 200 1st St SW, Rochester, MN, 55906, USA. Electronic address:
Postoperative anaemia is common among surgical patients. While often viewed as a benign condition, postoperative anaemia is neither inevitable nor harmless, being intricately linked with adverse outcomes. In this review, we summarize the prevalence, aetiology, and outcomes of postoperative anaemia and highlight prevention and management strategies.
View Article and Find Full Text PDFDiagnosing iron deficiency: Controversies and novel metrics.
Best Pract Res Clin Anaesthesiol
December 2023
Division of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
Iron deficiency, a pervasive global health issue, necessitates precise and reliable diagnostic methods, especially in clinical and surgical settings. This review examines an array of established markers of iron status, encapsulating parameters such as serum iron, ferritin, transferrin, and transferrin saturation alongside novel biomarkers like soluble transferrin receptor, zinc protoporphyrin, and hepcidin. We further scrutinise the potential and limitations of routine and novel diagnostic tools and strategies in distinguishing different anaemic conditions, such as iron deficiency anaemia, iron-restricted erythropoiesis, and anaemia of inflammation.
View Article and Find Full Text PDFChallenges in acute postoperative pain management in thoracic surgery.
Best Pract Res Clin Anaesthesiol
March 2024
Department of Anesthesiology, Columbia University, 622 W 168th St, New York, 10032, NY, United States. Electronic address:
Effective pain control is crucial in the management of thoracic surgical patients since it reduces postoperative morbidity and promotes recovery. These patients have co-existing respiratory diseases and impaired pulmonary function, which may be further impaired by surgery. With the adoption of minimally invasive surgical techniques and an emphasis on enhancing recovery after surgery, multimodal analgesia has gained popularity as a way to reduce perioperative opioid use and its associated adverse events such as respiratory depression.
View Article and Find Full Text PDFAnesthetic considerations for perioperative ECMO in lung transplantation.
Best Pract Res Clin Anaesthesiol
March 2024
Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA. Electronic address:
The care for lung transplantation patients is a complex, multidisciplinary coordination of physician and non-physician teams throughout the perioperative period. The diversity of etiologies of recipient end-stage lung disease further complicate care, as recipients often present with concomitant end-stage cardiac disease. Recently, the use of extracorporeal membrane oxygenation has become the mechanical circulatory support of choice to provide cardiopulmonary stability throughout the perioperative period.
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