1,721,039 research outputs found
Factor VII and thromboembolism
No full textRecombinant activated factor VIIa (rFVIIa) is a potent hemostatic agent originally developed for the treatment of haemophilia patients with inhibitors against factor FVIII or FIX. In approved indications, the safety profile of rFVIIa is favourable without major concerns. The prevalence of thromboembolic (TE) complications is less than 4/100.000 with fatal events being extremely rare. Also, the majority of reported events occurred in elderly patients with predisposing factors for TE complications. Currently, off-label use of rFVIIa has become much more common with intracerebral haemorrhage and major surgical procedures being one of the most investigated areas. However, the literature had controversial results with a dubious safety profile. While in intracerebral haemorrhage and cardiac surgery the administration of rFVIIa appears to increase the risk for TE adverse events, in trauma patients, variceal bleeding and liver transplantation the risk doesn't seem to be higher. Besides, no significant difference was reported in mortality rates. Moreover, a close monitoring for signs and symptoms of TE episodes is essential in patients treated with rFVIIa, especially the elderly and other patients with predisposing risk factors for thrombosis. In this opinion article, we aimed to review the current literature about the potential TE adverse events of rFVIIa in different clinical and surgical scenarios. (c) 2018 Published by Elsevier Ltd
Advanced airway management in out-of-hospital cardiac arrest - to intubate or not to intubate: a narrative review of the existing literature
No full textRestoring partial flow of oxygenated blood is a fundamental goal of cardiopulmonary resuscitation. The ideal devices used for this purpose should have features such as low incidence of complications, high survival rate, rapid control of the airway, and adequate ventilation. Besides limiting the frequency and duration of interruptions in chest compressions, they can improve the survival and clinical outcomes of return of spontaneous circulation during cardiopulmonary resuscitation. The overall rates of survival from out-of-hospital cardiac arrest have improved dramatically in recent years. However, optimal airway management during out-of-hospital cardiac arrest is a controversial issue. The proposed standard of care, i.e. endotracheal intubation, may have paradoxical adverse effects on intended outcomes by interrupting cardiopulmonary resuscitation and by reduction of coronary and cerebral perfusion pressure during resuscitation. The aim of this narrative review is to provide health care providers with an overview of relevant studies in the area, with a focus on alternative advanced airway techniques
Coagulopathy during liver transplantation
No full textIn this review article, we aimed to mainly review the principles for the management of hemostasis, changes that occur in the hemostatic system, and the techniques to reduce hemorrhage during liver transplantation. Hemostasis is a defense mechanism that may ensue from vascular damage and hemorrhage and consists of multiple phases which involve cellular and humoral elements of coagulation. In the presence of a cause, such as trauma-induced liver injury or hepatic failure that may trigger coagulopathy, the process becomes more problematic, and moreover, severe coagulation disorders may arise in daily practice unless the situation is intervened correctly and on time. During liver transplantation, the implementation of transfusion and coagulation management algorithms based on the point of care tests may reduce blood loss and transfusion requirement. Moreover, antifibrinolytic therapy and a low central venous pressure with restrictive fluid administration reduce bleeding
Does Transfusion of Blood and Blood Products Increase the Length of Stay in Hospital?
No full textWe aimed to analyze the use of blood products in cardiac surgery and to investigate its effect on clinical outcomes. Perioperative transfusion requirement, survival and complication rates and the duration of hospitalization were noted. Patients were divided into two groups considering the duration of hospital and intensive care unit (ICU) stay. The cardiopulmonary bypass time and the cross clamp time, and the amount of used cryoprecipitate, fresh frozen plasma, platelet, red blood cell and the bleeding amount were significantly higher in groups that stayed at the hospital for >7days and at the ICU for >2days (p>0.05). In the univariate model, to predict the patients who might stay at the hospital for more than 1week and who might stay at the ICU for more than 3days, we considered the significant efficacy of postoperative blood transfusion, bleeding amount, and the cardiopulmonary bypass time (p<0.05). In the reduced multivariate model, however, we analyzed the significant-independent efficacy of the postoperative fresh frozen plasma use to determine the patients who would stay at the hospital for more than 1week and who would stay at the ICU for more than 3days (p<0.05). We have concluded that increased use of blood products was associated with the cross clamp and cardiopulmonary bypass time and prolonged duration of hospital and ICU stays. In open cardiac surgeries, the use of blood products due to bleeding was identified as a predictor for staying longer than 3days at the ICU and longer than 7days at the hospital
Comparative study of fentanyl and morphine in addition to hyperbaric or isobaric bupivacaine in combined spinal anaesthesia for caesarean section
No full textIntroduction: The aim of our study was to compare the effects of isobaric and hyperbaric bupivacaine combined with morphine or fentanyl in patients undergoing caesarean section. We assessed quality and spread of analgesia and anaesthesia, postoperative analgesic requirement and side effects. Material and methods: Hundred patients with American Society of Anesthesiologists physical status (ASA) I-II, age 18 to 40 years, were randomized to 4 groups. The intrathecal solutions were isobaric bupivacaine + morphine (group A), isobaric bupivacaine + fentanyl (group B), heavy bupivacaine + + morphine (group C) and heavy bupivacaine + fentanyl (group D). Mean arterial pressure, heart rate, oxygen saturation, ephedrine consumption, analgesic requirement time and additional analgesic needs were recorded. Results: The 1(st) min value of mean arterial pressure was the lowest one in all groups. Heart rate decreased significantly in group A at the 10(th) min but not in the other groups. The decrease of visual analogue scale (VAS) pain scores began in the groups after the 4(th) postoperative h (p < 0.05) and the VAS value of group B at the 8(th) h was significantly higher than the other groups. The first analgesic requirement time in the postoperative period was longer in patients who had intrathecal morphine than those who had fentanyl. The duration of analgesia with isobaric bupivacaine and morphine was the longest one. Conclusions: We concluded that intrathecal morphine provides a long duration of postoperative analgesia but the duration gets longer when it is combined with plain bupivacaine instead of heavy bupivacaine
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