RESUMEN
OBJECTIVE: To examine whether specific platelet pheresis (minimal plasma harvested) would contribute toward reduced blood loss and allogenic blood requirements after cardiac surgery. DESIGN: A prospective randomized trial. SETTING: A large cardiothoracic surgical center. PARTICIPANTS: Consenting patients undergoing routine coronary artery or valve surgery (n = 54). INTERVENTIONS: Patients in the pheresis group underwent platelet pheresis in the anesthetic preparation room before general anesthesia. Pheresed platelets were stored during cardiopulmonary bypass and were returned to the patients after reversal of heparin with protamine toward the end of surgery. Control patients underwent their operations without this intervention. MEASUREMENTS AND MAIN RESULTS: Primary endpoints were blood loss and transfusion requirements. There were no differences between the 2 groups (pheresis v control: median loss, 960 mL v 1100 mL, p = 0.15; median blood transfused, 896 mL v 635 mL, p = 0.71). Secondary endpoints included analysis of platelet counts, platelet function, and surface markers. Counts remained the same after retransfusion of platelets up to 2 hours after surgery. Platelet aggregation to ristocetin was well preserved, but adenosine diphosphate caused almost no aggregation of the harvested platelets. Flow cytometry revealed the platelets to have a reduced surface density of the glycoprotein 1b receptor, and 13% of them were irreversibly activated. CONCLUSION: Platelet pheresis activates a proportion of the harvested platelets and impairs the function of the remainder; this may explain its failure to reduce postoperative blood loss and transfusion requirements.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Plaquetoferesis , Anciano , Pérdida de Sangre Quirúrgica , Plaquetas/metabolismo , Transfusión Sanguínea , Femenino , Hematócrito , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Selectina-P/análisis , Sustitutos del Plasma/administración & dosificación , Activación Plaquetaria , Agregación Plaquetaria/efectos de los fármacos , Recuento de Plaquetas , Complejo GPIb-IX de Glicoproteína Plaquetaria/análisis , Cuidados Preoperatorios , Estudios ProspectivosRESUMEN
Endoscopy of the upper airways in neonates and infants was traditionally been accomplished using rigid laryngoscopes and bronchoscopes. The laryngeal mask may be used both to control the airway for anaesthetic ventilation and to guide a fibre-optic endoscope to the laryngeal inlet and beyond. We report our experience with five neonatal and paediatric cases where fibre-optic laryngoscopy and bronchoscopy were performed through the laryngeal mask airway. All were cases in which standard rigid endoscopy had proved difficult with only a poor and restricted view of the laryngeal inlet being obtained due to the age of the infants, or abnormal anatomy of the upper airways. No problems have been encountered with maintenance of the airway or with endoscopic view obtained. In fact in neonatal patients, this technique has been found to be preferable with regard to safety and ease of use when compared to the ventilating bronchoscope. With the size 1 laryngeal mask airway it is not possible to simultaneously ventilate and endoscope the patient. Cases included, a vascular ring, Goldenhar's syndrome, laryngomalacia, supraglottis and vocal fold paresis. This technique provides a secure method of maintaining anaesthetic ventilation during airway endoscopy, and also a means of easily locating the glottis.
Asunto(s)
Broncoscopía/métodos , Máscaras Laríngeas , Laringoscopía/métodos , Epiglotis/anomalías , Epiglotitis/diagnóstico , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Ruidos Respiratorios/etiología , Parálisis de los Pliegues Vocales/diagnósticoRESUMEN
Although first reported in 1862, the fat embolism syndrome continues to arouse controversy. Current views on its pathophysiology, diagnosis, treatment and prophylaxis are reviewed here.
Asunto(s)
Embolia Grasa/terapia , Embolia Grasa/diagnóstico , Embolia Grasa/fisiopatología , Humanos , PronósticoRESUMEN
Sixty-five patients undergoing a thoracic procedure were randomly allocated to one of two groups. The first group received a conventional method of ventilation (double-lumen endobronchial tube and collapse of one lung) and the second, high-frequency jet ventilation (HFJV). The incidence of postoperative chest infections (clinical and bacteriological), the chest drain volumes, and the length of postoperative stay in the hospital were recorded. Results showed the jet ventilator group had a significantly reduced mean hospital stay (p less than 0.01), which could be attributed to a lower incidence of postoperative chest infections (p less than 0.001) and significantly improved arterial blood O2 tensions at 4 hours (p less than 0.05), 24 hours, and 7 days postoperatively (p less than 0.001).
Asunto(s)
Ventilación con Chorro de Alta Frecuencia , Ventilación con Presión Positiva Intermitente , Neumonectomía , Respiración con Presión Positiva , Complicaciones Posoperatorias/epidemiología , Análisis de los Gases de la Sangre , Estudios de Evaluación como Asunto , Humanos , Complicaciones Posoperatorias/prevención & control , Intercambio Gaseoso Pulmonar , Distribución AleatoriaRESUMEN
We report a case of congenital triple valve stenosis with dominant pulmonary valve disease, sparing the aortic valve, presenting at the age of 51 years with progressive shortness of breath and central cyanosis. At post mortem, no intracardiac right to left communication could be demonstrated.