Review of the off-label use of recombinant activated factor VII in pediatric cardiac surgery patients.


:In recent years the off-label use of recombinant activated factor VII (rFVIIa) has markedly increased, particularly in pediatric cardiac surgery patients, and practitioners differ widely in their usage of the drug. In 2009, the Congenital Cardiac Anesthesia Society (CCAS) assembled a task force to review the literature on rFVIIa administration to pediatric cardiac surgery patients. The goal of the CCAS Task Force was to assess current practices and make recommendations about rFVIIa therapy to enhance quality of care, improve patient outcomes, reduce costs, and develop future research. In this review we summarized the important topics on current administration of rFVIIa to pediatric cardiac surgery patients including indications for use, efficacy, safety, dosing, and monitoring. All pediatric and pertinent adult literature regarding the administration of rFVIIa to cardiac surgical patients and published since 2000 were selected and studied. Of the 40 pediatric publications reviewed for this report, only 1 was a prospective randomized controlled trial thus making determinations of efficacy difficult. There is no substantive evidence to support the efficacy of rFVIIa as prophylactic or routine therapy during pediatric cardiac surgery. It may prove reasonable as rescue therapy because current observational evidence suggests that potential benefits of rFVIIa for this indication might outweigh the risks. Rescue therapy is appropriate for bleeding that is massive, potentially life-threatening, and refractory to conventional therapy. Nevertheless, extreme caution is advised when considering the administration of rFVIIa to patients who are at risk for thromboembolic complications because rates for clinical and subclinical thrombosis secondary to rFVIIa therapy are unknown at this time. This review is designed to aid practitioners in deciding when and how to administer rFVIIa to pediatric cardiac surgery patients; it is not intended to determine standard-of-care or practice guidelines. There are insufficient data to make evidence-based recommendations. Randomized controlled trials are needed to assess the efficacy of rFVIIa as prophylactic, routine, or rescue therapy and to determine the drug's safety profile particularly with regard to thrombosis. The CCAS rFVIIa Task Force will continue to monitor the literature, gather data, and make updates as more information becomes available.


Anesth Analg


Anesthesia and analgesia


Guzzetta NA,Russell IA,Williams GD




Has Abstract


2012-08-01 00:00:00














  • Dexmedetomidine, an alpha 2-adrenergic agonist, decreases cerebral blood flow in the isoflurane-anesthetized dog.

    abstract::The purpose of this study was to examine the effects of dexmedetomidine, an alpha 2-adrenergic agonist, on cerebral blood flow and metabolic rate in dogs anesthetized with 0.64% isoflurane. After intubation and institution of mechanical ventilation, arterial, venous, pulmonary artery, and sagittal sinus catheters were...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Zornow MH,Fleischer JE,Scheller MS,Nakakimura K,Drummond JC

    更新日期:1990-06-01 00:00:00

  • Intraoperative Red Blood Cell Transfusion in Infant Heart Transplant Patients Is Not Associated with Worsened Outcomes.

    abstract:BACKGROUND:Red blood cell (RBC) transfusion is common during infant cardiac surgery. A previous report of pediatric heart transplant recipients showed that increased RBC transfusion volume was independently associated with increased length of intensive care unit stay. It is unclear whether transfusion to infants as a s...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Carter HF,Lau C,Juma D,Wells B,Applegate RL 2nd

    更新日期:2016-05-01 00:00:00

  • Comparison of ketamine and thiopental in healthy volunteers: effects on mental status, mood, and personality.

    abstract::The purpose of this study was to compare the psychological effects of ketamine and thiopental anesthesia. In a double-blind comparison, 20 normal female volunteers were given 2.5 mg/kg ketamine intravenously and 20 were given 5.0 mg/kg thiopental intravenously. Subjects were assessed with a variety of objective and su...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Moretti RJ,Hassan SZ,Goodman LI,Meltzer HY

    更新日期:1984-12-01 00:00:00

  • The effect of positive end-expiratory pressure level on peak expiratory flow during manual hyperinflation.

    abstract::Including positive end-expiratory pressure (PEEP) in the manual resuscitation bag (MRB) may render manual hyperinflation (MHI) ineffective as a secretion maneuver technique in mechanically ventilated patients. In this study we aimed to determine the effect of increased PEEP or decreased compliance on peak expiratory f...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Savian C,Chan P,Paratz J

    更新日期:2005-04-01 00:00:00

  • Propofol inhibits ketamine-induced c-fos expression in the rat posterior cingulate cortex.

    abstract:UNLABELLED:Ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, has psychotomimetic activity. NMDA receptor antagonists cause morphological damage in the posterior cingulate cortex, which may be the brain region responsible for their psychotomimetic effects. Benzodiazepines are effective in preve...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Nagata A,Nakao S,Miyamoto E,Inada T,Tooyama I,Kimura H,Shingu K

    更新日期:1998-12-01 00:00:00

  • Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine.

    abstract:BACKGROUND:Sugammadex is a modified [gamma] cyclodextrin compound, which encapsulates rocuronium to provide for a rapid reversal of residual neuromuscular blockade. We tested the hypothesis that sugammadex would provide for a more rapid reversal of a moderately profound residual rocuronium-induced blockade than the com...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验


    authors: Sacan O,White PF,Tufanogullari B,Klein K

    更新日期:2007-03-01 00:00:00

  • Validating the Physiologic Model HumMod as a Substitute for Clinical Trials Involving Acute Normovolemic Hemodilution.

    abstract:BACKGROUND:Blood conservation strategies and transfusion guidelines remain a heavily debated clinical topic. Previous investigational trials have shown that acute isovolemic hemodilution does not limit adequate oxygen delivery; however, a true critical hemoglobin level has never been investigated or defined due to safe...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Sims CR 3rd,Delima LR,Calimaran A,Hester R,Pruett WA

    更新日期:2018-01-01 00:00:00

  • Lateral approach to the sciatic nerve in the popliteal fossa.

    abstract:UNLABELLED:We describe a modification of the sciatic nerve (SN) block in the popliteal fossa through the lateral approach. After a brief anatomic study using previously reported landmarks, we propose a new needle orientation associated with a double injection technique after identification of the tibial and the common ...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Zetlaoui PJ,Bouaziz H

    更新日期:1998-07-01 00:00:00

  • Hemodynamic dose-responses to halothane and isoflurane are different in swine with and without critical coronary artery stenosis.

    abstract::This study examined global hemodynamic responses to increasing concentrations of halothane and isoflurane in pigs with an acute critical coronary stenosis (CCS) on the left anterior descending coronary artery (LAD). The CCS was caused by graded inflation of an hydraulic occluder to the point where no hyperemic respons...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Gilbert M,Mori M,Myhre ES

    更新日期:1989-06-01 00:00:00

  • Vasoconstrictors in spinal anesthesia with tetracaine--a comparison of epinephrine and phenylephrine.

    abstract::A randomized double-blind study was conducted in 50 orthopedic patients to determine the effect of epinephrine and phenylephrine on the anesthetic properties of intrathecally administered tetracaine. Two doses of each vasoconstrictor agent were studied: 0.2 mg of epinephrine, 0.3 mg of epinephrine, 1 mg of phenylephri...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Concepcion M,Maddi R,Francis D,Rocco AG,Murray E,Covino BG

    更新日期:1984-02-01 00:00:00

  • Unrepaired Tetralogy of Fallot-related Pathophysiologic Changes Reduce Systemic Clearance of Etomidate in Children.

    abstract:BACKGROUND:Pathophysiologic changes in children with congenital heart disease may alter the effect of drugs by influencing the pharmacokinetics (PK). Considering the limited literature that describes the PK of etomidate in pediatric patients, especially in those with tetralogy of Fallot (TOF), our aim was to characteri...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Shen Y,Cai MH,Ji W,Bai J,Huang Y,Sun Y,Lin L,Niu J,Zhang MZ

    更新日期:2016-09-01 00:00:00

  • Effects of sufentanil on cerebral blood flow, cerebral blood flow velocity, and metabolism in dogs.

    abstract::The intracranial and systemic hemodynamic effects of sufentanil (20 micrograms/kg) were studied in 10 mongrel dogs. Baseline anesthesia was maintained with 0.7% end-tidal isoflurane and 50% nitrous oxide in oxygen. Catheters were inserted for blood pressure measurement, arterial and sagittal sinus blood sampling, radi...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Werner C,Hoffman WE,Baughman VL,Albrecht RF,Schulte J

    更新日期:1991-02-01 00:00:00

  • The use of a laryngeal mask airway after a prolonged suspension laryngoscopy to preserve a vocal cord fat graft.

    abstract::A 62-yr-old man presented for a microdirect laryngoscopy and vocal cord fat grafting under jet ventilation. After a prolonged laryngoscopy, the patient developed hypercapnea and upper airway obstruction secondary to traumatic epiglottitis. The placement of a laryngeal mask airway provided ventilation and allowed for d...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Kidani DC,Shah NK

    更新日期:2007-12-01 00:00:00

  • The Effects of Continuous Positive Airway Pressure on Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing Surgery: A Systematic Review and Meta-analysis.

    abstract:BACKGROUND:Obstructive sleep apnea (OSA) is a commonly encountered comorbid condition in patients undergoing surgery and is associated with a greater risk of postoperative adverse events. Our objective in this review was to investigate the effectiveness of continuous positive airway pressure (CPAP) in reducing the risk...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,meta分析,评审


    authors: Nagappa M,Mokhlesi B,Wong J,Wong DT,Kaw R,Chung F

    更新日期:2015-05-01 00:00:00

  • The impact of carrier flow rate and infusion set dead-volume on the dynamics of intravenous drug delivery.

    abstract::The dynamics of IV drug delivery resulting from drug infusions connected to main-line crystalloid carriers can be complex and depend on infusion set dead-volume, drug flow rate, and carrier flow rate. While the concept of dead-volume is intuitive, a lack of appreciation of the interaction with the carrier and drug flo...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Lovich MA,Doles J,Peterfreund RA

    更新日期:2005-04-01 00:00:00

  • Energy dose and other variables possibly affecting ventricular defibrillation during cardiac surgery.

    abstract::Previous studies have suggested that shocks of 5-10 J are required for direct ventricular defibrillation during open heart surgery. However, the efficacy of shocks of less than 5 J, the effects of thermal, biochemical, and temporal factors, and the influence of disease process on defibrillation have not been fully inv...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Lake CL,Sellers TD,Nolan SP,Crosby IK,Wellons HA Jr,Crampton RS

    更新日期:1984-08-01 00:00:00

  • Spinal 2-chloroprocaine: a comparison with lidocaine in volunteers.

    abstract:UNLABELLED:Subarachnoid lidocaine has been the anesthetic of choice for outpatient spinal anesthesia. However, its use is associated with transient neurologic symptoms (TNS). Preservative-free formulations of 2-chloroprocaine are now available and may compare favorably with lidocaine for spinal anesthesia. In this doub...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Kouri ME,Kopacz DJ

    更新日期:2004-01-01 00:00:00

  • An in situ technique to retrieve an entrapped j-tip guidewire from an inferior vena cava filter.

    abstract:IMPLICATIONS:Entrapment of a guidewire in the vena cava filter during central venous catheter placement is a newly recognized complication. Complex techniques have been described to free the guidewire. We describe a simple in situ technique that may free the guidewire without the application of complex techniques. ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Munir MA,Chien SQ

    更新日期:2002-08-01 00:00:00

  • Criteria for selection of ambulatory surgical patients and guidelines for anesthetic management: a retrospective study of 1553 cases.

    abstract::The charts of 1553 patients who were anesthetized for ambulatory surgery were analyzed retrospectively to determine the effect of the type of surgery, the age of the patient, the use of premedication, the duration of anesthesia, and the anesthetic technique on the duration of recovery and the rate of complications. In...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Meridy HW

    更新日期:1982-11-01 00:00:00

  • The screening of propofol in MHS swine.

    abstract::This study investigated the use of propofol in swine genetically susceptible to malignant hyperthermia (MH). Thirteen animals were exposed to 2% halothane in inspired air, a propofol infusion of 12 for up to 45 min, or a combination of both. When MH was triggered the animals were treated with dantrolene. ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Raff M,Harrison GG

    更新日期:1989-06-01 00:00:00

  • Esophageal insufflation with normal fiberoptic positioning of the ProSeal laryngeal mask airway.

    abstract:IMPLICATIONS:Esophageal insufflation can occur simultaneously with venting from the drain tube during positive pressure ventilation with the ProSeal laryngeal mask airway. ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Stix MS,Borromeo CJ,O'Connor CJ Jr

    更新日期:2002-04-01 00:00:00

  • Electrocerebral silence by intracarotid anesthetics does not affect early hyperemia after transient cerebral ischemia in rabbits.

    abstract:UNLABELLED:Evidence suggests that early postischemic hyperemia is mediated by both neurological and vascular mechanisms. We hypothesized that if neuronal activity were primarily responsible for reperfusion hyperemia, then electrocerebral silence induced by intracarotid anesthetics (propofol and pentothal) would attenua...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Joshi S,Wang M,Nishanian EV,Emerson RG

    更新日期:2004-05-01 00:00:00

  • Rapid tracheal intubation with large-dose rocuronium: a probability-based approach.

    abstract:UNLABELLED:There are situations in anesthesia in which it may be desirable to achieve rapid tracheal intubation with perfect conditions, i.e., no coughing or straining. To determine the dose of rocuronium that gives a high probability of achieving perfect conditions for rapid (within 60 s) tracheal intubation, we admin...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Heier T,Caldwell JE

    更新日期:2000-01-01 00:00:00

  • Fenoldopam mesylate and renal function in patients undergoing liver transplantation: a randomized, controlled pilot trial.

    abstract::To test the relative effects on serum creatinine (CRE), blood urea nitrogen (BUN), and urine output of small-dose dopamine and fenoldopam in patients undergoing liver transplantation, we randomized 43 patients to 1 of 2 continuous infusions over 48 h, starting with anesthesia induction: fenoldopam, 0.1 microg . kg(-1)...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Della Rocca G,Pompei L,Costa MG,Coccia C,Scudeller L,Di Marco P,Monaco S,Pietropaoli P

    更新日期:2004-12-01 00:00:00

  • Propofol attenuates lung endothelial injury induced by ischemia-reperfusion and oxidative stress.

    abstract::Lung dysfunction after cardiopulmonary bypass and lung transplantation results from oxidant-mediated cellular damage. Previously, we observed the shedding of angiotensin-converting enzyme (ACE) from the endothelial cell surface to be a more sensitive and earlier marker of oxidative lung endothelial injury than lung we...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Balyasnikova IV,Visintine DJ,Gunnerson HB,Paisansathan C,Baughman VL,Minshall RD,Danilov SM

    更新日期:2005-04-01 00:00:00

  • The analgesic effect of tramadol after intravenous injection in healthy volunteers in relation to CYP2D6.

    abstract::Tramadol analgesia results from a monoaminergic effect by tramadol itself and an opioid effect of its metabolite (+)-M1 formed by O-demethylation of tramadol by CYP2D6. In this study we sought to determine the impact of (+)-M1 on the analgesic effect of tramadol evaluated by experimental pain models. The effect of an ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验


    authors: Enggaard TP,Poulsen L,Arendt-Nielsen L,Brøsen K,Ossig J,Sindrup SH

    更新日期:2006-01-01 00:00:00

  • Electronic Audit and Feedback With Positive Rewards Improve Anesthesia Provider Compliance With a Barcode-Based Drug Safety System.

    abstract:BACKGROUND:We implemented a previously described barcode-based drug safety system in all of our anesthetizing locations. Providers were instructed to scan the barcode on syringes using our Anesthesia Information Management System before drug administration, but the rate of provider adherence was low. We studied an impl...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Bowdle TA,Jelacic S,Nair B,Zucker F,Bussey LS,Togashi K,Yang JT,Lang J

    更新日期:2019-08-01 00:00:00

  • Analgesia and Sedation Requirements in Mechanically Ventilated Trauma Patients With Acute, Preinjury Use of Cocaine and/or Amphetamines.

    abstract:BACKGROUND:The purpose of this study was to determine whether mechanically ventilated trauma patients with a positive urine drug screen (UDS) for cocaine and/or amphetamines have different opioid analgesic and sedative requirements compared with similar patients with a negative drug screen for these stimulants. METHOD...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Kram B,Kram SJ,Sharpe ML,James ML,Kuchibhatla M,Shapiro ML

    更新日期:2017-03-01 00:00:00

  • Computed tomography-estimated specific gravity of noncontused brain areas as a marker of severity in human traumatic brain injury.

    abstract::In this study, we assessed the relationship between brain estimated specific gravity (eSG) and clinical symptoms, therapeutic intensity level, and outcome in human traumatic brain injury (TBI). Brain weight, volume, and eSG of the noncontused hemispheric areas were measured from computed tomography (CT) DICOM images o...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Degos V,Lescot T,Zouaoui A,Hermann H,Préteux F,Coriat P,Puybasset L

    更新日期:2006-11-01 00:00:00

  • Myocardial perfusion following acute subarachnoid hemorrhage in patients with an abnormal electrocardiogram.

    abstract::To test the hypothesis that acute subarachnoid hemorrhage is associated with abnormal myocardial perfusion, we assessed myocardial blood flow with thallium scintigraphy in 19 patients with a confirmed subarachnoid hemorrhage and an abnormal electrocardiogram. A thallium scan was performed at the bedside of each patien...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Szabo MD,Crosby G,Hurford WE,Strauss HW

    更新日期:1993-02-01 00:00:00