Abstract:
BACKGROUND:Recent randomized controlled trials have shown no benefit for transfusion to a hemoglobin >10 g/dL compared with lower hemoglobin thresholds in the perioperative period, even among older adults. Nevertheless, physicians may choose to transfuse older adults more liberally than younger adults. It is unclear whether older patients have higher odds than younger patients of being transfused in the perioperative period. Our objective in this study was to determine whether the odds of transfusion are higher in older patients than in younger patients in the perioperative period. METHODS:We conducted this retrospective observational cohort study at a tertiary care academic medical center. We included adults who had undergone a surgical procedure as an inpatient at our institution from January 2010 to February 2012. The primary analysis compared the odds of transfusion for patients >65 years old with the odds of transfusion in younger patients based on multilevel multivariable logistic regression analyses including adjustment for comorbidities, surgical service, lowest in-hospital hemoglobin value, gender, and estimated surgical blood loss and accounted for clustering by the surgeon and procedure. RESULTS:We included 20,930 patients in this analysis. In multilevel models adjusted for comorbidities, surgical service, estimated surgical blood loss, and lowest in-hospital hemoglobin value, with surgeon and procedure as random effects, patients > 65 years old had 62% greater odds (odds ratio, 1.62; 95% confidence interval, 1.40-1.88; P < 0.0001) of being transfused than did younger patients. When patients were stratified by lowest in-hospital hemoglobin (7.00-7.99, 8.00-8.99, 9.00-9.99, and ≥10.00 g/dL), the odds of transfusion generally increased with each additional decade of age in every stratum, except for that containing patients in whom the lowest in-hospital hemoglobin did not decrease below 10 g/dL. When the odds of transfusion were compared between younger and older patients, significant differences were observed among surgical services (P = 0.02) but not among anesthesia specialty divisions (P = 0.9). CONCLUSIONS:Older adults have greater odds of receiving red blood cell transfusion in the perioperative period than do younger patients, despite the lack of evidence supporting higher hemoglobin triggers in elderly patients. Further research is needed to determine whether transfusion practice in the elderly is an opportunity for education to improve blood management.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Brown CH 4th,Savage WJ,Masear CG,Walston JD,Tian J,Colantuoni E,Hogue CW,Frank SMdoi
10.1213/ANE.0000000000000033subject
Has Abstractpub_date
2014-06-01 00:00:00pages
1168-78issue
6eissn
0003-2999issn
1526-7598journal_volume
118pub_type
杂志文章abstract:BACKGROUND:Perioperative opioid use is associated with poor survival in patients with esophageal squamous cell carcinoma. The most common histological type of esophageal cancer in western countries is adenocarcinoma. The objective of this study was to evaluate the association between intraoperative opioid consumption a...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003428
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:The increasing demand for anesthetic procedures in the gastrointestinal endoscopy area has not been followed by a similar increase in the methods to provide and control sedation and analgesia for these patients. In this study, we evaluated different combinations of propofol and remifentanil, administered thr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3182025a70
更新日期:2011-02-01 00:00:00
abstract:UNLABELLED:Morbidly obese (MO) patients undergoing laparoscopy have lower PaO(2) compared with normal-weight (NW) patients. We hypothesized that increases in tidal volume (V(T)) or respiratory rate (RR) would improve oxygenation. All measurements were performed at: 1) baseline: V(T) 600-700 mL and 10 breaths/min, 2) do...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000067409.33495.1f
更新日期:2003-07-01 00:00:00
abstract::During surgery, patients are exposed to multiple foreign substances including anesthetic drugs, antibiotics, blood products, heparin, polypeptides (aprotinin, latex, and protamine), and intravascular volume expanders, which have the potential to produce life-threatening allergic reactions termed "anaphylaxis." The hal...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ane.0b013e3181602e0d
更新日期:2008-02-01 00:00:00
abstract::The brain is one of the most metabolically active organs in the body. The brain's high energy demand associated with wakefulness persists during rapid eye movement sleep, and even during non-rapid eye movement sleep, cerebral oxygen consumption is only reduced by 20%. The active bioenergetic state parallels metabolic ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000004069
更新日期:2019-04-01 00:00:00
abstract::The hemodynamic effects of an induction dose of propofol, 2.5 mg/kg, or etomidate, 0.3 mg/kg, were studied in eight dogs. In addition, cardiodynamic changes were measured using a left ventricular catheter and needle force probes. Propofol was associated with significant decreases in systolic (19.9%) and diastolic (25....
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1989-07-01 00:00:00
abstract:IMPLICATIONS:We report a unique case of acute anaphylaxis after mediastinal irrigation with a dilute bacitracin solution. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200010000-00049
更新日期:2000-10-01 00:00:00
abstract::We investigated the appropriateness of the somatosensory evoked potentials (SSEPs) as an objective monitor of sensory blockade of the ulnar nerve by comparing the effects of saline and lidocaine infiltration of the ulnar nerve at the elbow, with and without epinephrine. The four treatments were administered in random ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1986-08-01 00:00:00
abstract::Single channel recordings have shown that ketamine (Ket) decreases the open time of the nicotinic acetylcholine receptor channel (nAChR). The present experiments on simultaneous openings of the nAChRs of mouse myotubes investigate the interaction of Ket with the open as well as with the closed state of the channels. T...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199610000-00031
更新日期:1996-10-01 00:00:00
abstract:UNLABELLED:We constructed a single-dose response curve for succinylcholine in 30 obese adolescents during thiopental-fentanyl anesthesia administration by using 100 microg/kg, 150 microg/kg, or 250 microg/kg IV. The maximal response (percent depression of neuromuscular function) of the adductor pollicis to supramaximal...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200003000-00015
更新日期:2000-03-01 00:00:00
abstract::Calciphylaxis is a small-vessel disease associated with renal failure. Here, we report the management of a 43-yr-old man with calciphylaxis who received left lower leg amputation with prostaglandin E(1) (PGE(1)) under monitoring by laser Doppler blood flowmetry in the left second and third fingers. Anesthesia was indu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000121960.22554.D7
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:Risk of intraoperative hypothermia is relatively high in middle-aged and elderly patients undergoing curative resection of esophageal cancer, which may cause myocardial ischemia during the early postoperative period. The objective of this study was to compare aggressive or standard body temperature managemen...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000004022
更新日期:2019-08-01 00:00:00
abstract::Evaluation of a new inhaled anesthetic requires determination of the anesthetic's potential to predispose to ventricular (and other) arrhythmias in an animal model. This need poses logistic and economic burdens if the effects of large numbers of new anesthetics are to be surveyed. We have devised a technique for deter...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199006000-00013
更新日期:1990-06-01 00:00:00
abstract::The Bonfils Retromolar Intubation Fiberscope is a rigid, straight fiberoptic device with a 40-degree curved tip, which facilitates targeted intubation. Bonfils, using a retromolar approach to intubate tracheas of children with Pierre Robin syndrome, was first described in 1983. After an initial steep learning curve, t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e318265bae2
更新日期:2012-10-01 00:00:00
abstract::There has been no description of the hemodynamic dose-response relationship between halothane and sodium nitroprusside (SNP), although these drugs are used together frequently for induction of deliberate hypotension. Utilizing aortic root cannulation and thermister-tipped pulmonary artery catheterization, this relatio...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197807000-00016
更新日期:1978-07-01 00:00:00
abstract:BACKGROUND:In children, the laryngeal mask airway (LMA) is frequently displaced within the hypopharynx, resulting in repositioning of the device. When the tip of the LMA is placed in the esophageal inlet, the arytenoids are moved ventrally. When the LMA is rotated or deviated, the ventral movement of the arytenoids may...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000551
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:In vivo animal assays are a cornerstone of preclinical pain research. An optimal stimulus for determining the activity of potential analgesics would produce responses of a consistent magnitude on repeated testing. Intraplantar (i.pl.) injection of hypertonic saline (HS) in mice produces robust nociceptive re...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003593
更新日期:2019-07-01 00:00:00
abstract::The pharmacokinetics of fentanyl were studied in fourteen neonates undergoing major surgical procedures. Five patients were less than 1 day of age, seven were 1-4 days old, and two were 7-14 days old. Fentanyl was given intravenously, 10 micrograms/kg (n = 1), 25 micrograms/kg (n = 4), or 50 micrograms/kg (n = 9), and...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1986-03-01 00:00:00
abstract::Epidural catheter placement offers flexibility in block management. However, during epidural catheter insertion, complications such as paresthesia and venous and subarachnoid cannulation may occur, and suboptimal catheter placement can affect the quality of anesthesia. We performed this prospective, randomized, double...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000181005.50958.1E
更新日期:2005-11-01 00:00:00
abstract:UNLABELLED:Opioid medication is the mainstay of therapy for severe acute and chronic pain. Unfortunately, the side effects of these medications can affect patient comfort and safety, thus limiting their proven therapeutic potential. Whereas the main analgesic effects of opioids are centrally mediated, many of the commo...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/01.ane.0000090147.97636.77
更新日期:2004-01-01 00:00:00
abstract::Thirty patients undergoing craniotomies were given infusions of fentanyl 1 microgram X kg-1 X hr-1, sufentanil 0.1 microgram X kg-1 X hr-1, or normal saline in a double-blind study of cerebral relaxation. Significantly better relaxation scores were achieved in patients given a narcotic infusion, but there was no diffe...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/00000539-198705000-00007
更新日期:1987-05-01 00:00:00
abstract:UNLABELLED:The Bispectral Index (BIS) correlates well with the level of consciousness with single anesthetic drugs. We studied the effect of the interaction of propofol with alfentanil on propofol concentration and BIS associated with 50% probability of loss of consciousness and lack of recall (Cp50 and BIS50, respecti...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199810000-00038
更新日期:1998-10-01 00:00:00
abstract::To clarify the effect of hematocrit on the solubility of volatile anesthetics in blood, we measured the blood-gas partition coefficients of isoflurane, enflurane, halothane, and methoxyflurane concurrently at 37 degrees C in blood from four adults. We measured the blood-gas partition coefficients in the plasma (hemato...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1984-10-01 00:00:00
abstract::We built and tested a combined proportional/derivative and minimum variance adaptive control algorithm for the regulation of blood pressure using sodium nitroprusside (SNP). In ten dogs the pressure was reduced by 30 mm Hg for 1 hr. The blood pressure came to within 5 mm Hg of the desired pressure in 1.7 +/- 4 min and...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND:Chronic pain is one of the most common complaints in patients with human immunodeficiency virus (HIV)-associated sensory neuropathy. Ryanodine receptor (RyR) and mitochondrial oxidative stress are involved in neuropathic pain induced by nerve injury. Here, we investigated the role of RyR and mitochondrial su...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003916
更新日期:2019-07-01 00:00:00
abstract:IMPLICATIONS:This case report shows that atelectasis of the left lung-induced by extrinsic compression of the left main bronchus by an aortic aneurysm and persisting despite aggressive conservative treatment-may be effectively treated by bronchial stenting and high-frequency percussive ventilation. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200211000-00012
更新日期:2002-11-01 00:00:00
abstract::Controversy exists concerning the choice of anesthetic technic for elective cesarean section. Several maternal and newborn parameters were compared during general anesthesia (GA) and lumbar epidural analgesia (LEA). High inspired maternal O2 levels were achieved with both technics. Vigorous, well-oxygenated infants wi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1977-03-01 00:00:00
abstract::Sufentanil is a new synthetic opiate analgesic that is 4520 times more potent than morphine in animal experiments. This study evaluated the cardiovascular effects of sufentanil, 15 micrograms/kg, and air/O2 used as a complete anesthetic with 50% inspired oxygen (air/O2 mixture) in 40 adult patients undergoing elective...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1982-02-01 00:00:00
abstract:IMPLICATIONS:These results indicate that fetal exposure to propofol can vary considerably depending on maternal plasma albumin concentration. A fractional change in the maternal protein binding of propofol can result in a relatively large difference in fetal exposure. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200205000-00048
更新日期:2002-05-01 00:00:00
abstract:UNLABELLED:Postoperative pain has been an important limiting factor for ambulatory laparoscopic cholecystectomy. We anesthetized 40 ASA physical status I-II patients using propofol for the induction and sevoflurane in oxygen and air for the maintenance of anesthesia. At the end of the anesthesia, the patients were rand...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200208000-00040
更新日期:2002-08-01 00:00:00