Abstract:
BACKGROUND:Patient blood management combines the use of several transfusion alternatives. Integrated use of erythropoietin, cell saver, and/or postoperative drain reinfusion devices on allogeneic erythrocyte use was evaluated using a restrictive transfusion threshold. METHODS:In a factorial design, adult elective hip- and knee-surgery patients with hemoglobin levels 10 to 13 g/dl (n = 683) were randomized for erythropoietin or not, and subsequently for autologous reinfusion by cell saver or postoperative drain reinfusion devices or for no blood salvage device. Primary outcomes were mean allogeneic intra- and postoperative erythrocyte use and proportion of transfused patients (transfusion rate). Secondary outcome was cost-effectiveness. RESULTS:With erythropoietin (n = 339), mean erythrocyte use was 0.50 units (U)/patient and transfusion rate 16% while without (n = 344), these were 0.71 U/patient and 26%, respectively. Consequently, erythropoietin resulted in a nonsignificant 29% mean erythrocyte reduction (ratio, 0.71; 95% CI, 0.42 to 1.13) and 50% reduction of transfused patients (odds ratio, 0.5; 95% CI, 0.35 to 0.75). Erythropoietin increased costs by €785 per patient (95% CI, 262 to 1,309), that is, €7,300 per avoided transfusion (95% CI, 1,900 to 24,000). With autologous reinfusion, mean erythrocyte use was 0.65 U/patient and transfusion rate was 19% with erythropoietin (n = 214) and 0.76 U/patient and 29% without (n = 206). Compared with controls, autologous blood reinfusion did not result in erythrocyte reduction and increased costs by €537 per patient (95% CI, 45 to 1,030). CONCLUSIONS:In hip- and knee-replacement patients (hemoglobin level, 10 to 13 g/dl), even with a restrictive transfusion trigger, erythropoietin significantly avoids transfusion, however, at unacceptably high costs. Autologous blood salvage devices were not effective.
journal_name
Anesthesiologyjournal_title
Anesthesiologyauthors
So-Osman C,Nelissen RG,Koopman-van Gemert AW,Kluyver E,Pöll RG,Onstenk R,Van Hilten JA,Jansen-Werkhoven TM,van den Hout WB,Brand R,Brand Adoi
10.1097/ALN.0000000000000134subject
Has Abstractpub_date
2014-04-01 00:00:00pages
839-51issue
4eissn
0003-3022issn
1528-1175journal_volume
120pub_type
杂志文章,多中心研究,随机对照试验相关文献
ANESTHESIOLOGY文献大全abstract:INTRODUCTION:Directional connectivity from anterior to posterior brain regions (or "feedback" connectivity) has been shown to be inhibited by propofol and sevoflurane. In this study the authors tested the hypothesis that ketamine would also inhibit cortical feedback connectivity in frontoparietal networks. METHODS:Sur...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e31829103f5
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:Morbidly obese patients, during anesthesia and paralysis, experience more severe impairment of respiratory mechanics and gas exchange than normal subjects. The authors hypothesized that positive end-expiratory pressure (PEEP) induces different responses in normal subjects (n = 9; body mass index < 25 kg/m2) ...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章
doi:10.1097/00000542-199911000-00011
更新日期:1999-11-01 00:00:00
abstract:BACKGROUND:Although neuromuscular blocking agents do not cross the blood-brain barrier, they may penetrate the central nervous system under particular circumstances and eventually cause neurotoxic consequences. METHODS:The effects of neuromuscular blocking agents on excitatory and inhibitory transmission in area CA1 o...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199804000-00021
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:Midazolam and alfentanil are desirable anesthetic adjuncts for cardiac anesthesia. They are metabolized by cytochrome P450 3A (CYP3A) enzymes. These isozymes are inhibited by concurrent medications, including the calcium channel antagonist diltiazem, which may have an effect on recovery from anesthesia. MET...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199612000-00004
更新日期:1996-12-01 00:00:00
abstract:BACKGROUND:alpha 2 Agonists are powerful analgesics after spinal delivery. The current work characterizes the dose-dependent antinociception and effects upon respiratory function of dexmedetomidine after intrathecal, epidural, intravenous, and intracisternal delivery in chronically prepared dogs. METHODS:Dogs were pre...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199405000-00015
更新日期:1994-05-01 00:00:00
abstract:BACKGROUND:The authors determined the segmental effects of intracarotid verapamil in human subjects by using a novel method of measuring proximal and distal cerebrovascular resistance. Their hypothesis was that intracarotid verapamil, a calcium channel-blocking drug that augments cerebral blood flow and reverses arteri...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200404000-00005
更新日期:2004-04-01 00:00:00
abstract::Rats were given standardized injections of 3H-L-proline into the trigeminal ganglion and 14C-lidocaine hydrochloride at the infraorbital foramen. The 3H-L-proline was always injected 2.5 h before removal of the nerve. Lidocaine, 1, 2, and 4%, produced a concentration-related inhibition of entry of 3H-labeled rapid axo...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197602000-00009
更新日期:1976-02-01 00:00:00
abstract::Isoflurane has protective properties during experimental global brain ischemia or hypoxia. However, this has not been evaluated in the more common case of focal ischemia, e.g., as caused by middle cerebral artery occlusion (MCAO). The authors therefore compared the effects of isoflurane, thiopental, and N2O/fentanyl a...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198704000-00002
更新日期:1987-04-01 00:00:00
abstract:BACKGROUND:Xenon is a general anesthetic with neuroprotective properties. Xenon inhibition at the glycine-binding site of the N-Methyl-D-aspartate (NMDA) receptor mediates xenon neuroprotection against ischemic injury in vitro. Here we identify specific amino acids important for xenon binding to the NMDA receptor, with...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e31825ada2e
更新日期:2012-07-01 00:00:00
abstract::To study the effect of halothane on the coronary circulation, the circumflex diastolic coronary vascular resistance was measured in the working heart and total mean coronary resistance (TCR) in the isolated nonworking heart of the dog during administration of 100 per cent oxygen and during administration of 2--3 per c...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197704000-00002
更新日期:1977-04-01 00:00:00
abstract:BACKGROUND:Propofol and alfentanil frequently are administered together for intravenous sedation. This study investigated pharmacokinetic and pharmacodynamic interactions between propofol and alfentanil, at sedative concentrations, with specific regard to effects on ventilation, analgesia, sedation, and nausea. METHOD...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199601000-00004
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:The aim of this study was to characterize cervical cord, root, and bony spine claims in the American Society of Anesthesiologists Closed Claims database to formulate hypotheses regarding mechanisms of injury. METHODS:All general anesthesia claims (1970-2007) in the Closed Claims database were searched to id...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3182104859
更新日期:2011-04-01 00:00:00
abstract::The use of isoflurane in patients with coronary artery disease remains controversial because of the possibility of "coronary steal". In this study, the effects of isoflurane and halothane on global and regional myocardial blood flow and metabolism were compared, and the relationship between steal-induced myocardial is...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199111000-00006
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:In cardiac myocytes, lidocaine reduces but mexiletine increases adenosine triphosphate (ATP)-sensitive K+ currents, suggesting that these class Ib antiarrhythmic drugs may differentially modify the activity of ATP-sensitive K+ channels. The effects of lidocaine and mexiletine on arterial relaxations induced ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199904000-00032
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:The Pediatric Craniofacial Collaborative Group established the Pediatric Craniofacial Surgery Perioperative Registry to elucidate practices and outcomes in children with craniosynostosis undergoing complex cranial vault reconstruction and inform quality improvement efforts. The aim of this study is to determ...
journal_title:Anesthesiology
pub_type: 杂志文章,多中心研究
doi:10.1097/ALN.0000000000001481
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Anesthetics are protective during ischemic-reperfusion injury and associated inflammation; therefore, the authors hypothesized that anesthetic pretreatment may provide protection in culture from cytokine-induced cell death. METHODS:Rat vascular smooth muscle (VSM) cell and human umbilical vascular endotheli...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200207000-00005
更新日期:2002-07-01 00:00:00
abstract:BACKGROUND:Intrathecal methylprednisolone acetate (MPA) has been used in patients with chronic pain syndromes. Its safety has been debated after reports of adverse events. No systematic preclinical evaluation of MPA has been reported. In the current study, the acute and long-term effects of intrathecal MPA on dog spina...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e31823cf035
更新日期:2012-01-01 00:00:00
abstract::This study examined the interaction between thiopental and epinephrine in inducing ventricular arrhythmias in dogs. The arrhythmogenic threshold of epinephrine was determined during anesthesia with either halothane alone, thiopental alone, etomidate plus different doses of thiopental, or halothane plus different doses...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198912000-00017
更新日期:1989-12-01 00:00:00
abstract:BACKGROUND:Antioxidant anesthetics such as propofol (2,6-diisopropylphenol) directly inhibit lipid peroxidation via the generation of reactive oxygen species. Currently, there are no other studies regarding the direct effects of propofol medium chain triglyceride/long chain triglyceride (MCT/LCT) on reactive oxygen spe...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318182a903
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Whether intraoperative use of hydroxyethyl starch impairs kidney function remains unknown. The authors thus tested the primary hypothesis that Hextend promotes renal injury in surgical patients. Secondarily, the authors evaluated the dose-outcome relationship, in-hospital and 90-day mortality, and whether th...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000000375
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Although evidence of its effects is tentative, acupuncture has long been used in the treatment of multiple maladies. So far, it has not been possible to discriminate the effects of the venue from specific results of needling itself, thus physicians merely depend on patients' statements. The authors investiga...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/ALN.0b013e3181b31e24
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:General anesthetics reduce neuron loss following focal cerebral ischemia in rodents. The relative efficacy of this action among different anesthetics clinically used for neuroprotection is uncertain. In addition, it remains unclear how anesthetics compare to neuroprotection afforded by mild hypothermia. This...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200005000-00024
更新日期:2000-05-01 00:00:00
abstract::An important guideline for anesthesia in patients with ischemic heart disease is the effect on myocardial oxygen demand. Therefore, this investigation evaluated commonly used myocardial oxygen demand formulas for clinical application. The study was performed on patients undergoing coronary bypass surgery (n = 62). Mea...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199107000-00009
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:Adaptive support ventilation can speed weaning after coronary artery surgery compared with protocolized weaning using other modes. There are no data to support this mode of weaning after cardiac valvular surgery. Furthermore, control group weaning times have been long, suggesting that the results may reflect...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/ALN.0000000000000589
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Anesthetic preconditioning (APC) with sevoflurane reduces myocardial ischemia-reperfusion injury. The authors tested whether two brief exposures to sevoflurane would lead to a better preconditioning state than would a single longer exposure and whether dual exposure to a lower (L) concentration of sevofluran...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200403000-00016
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:The rate of administration of an intravenous anesthetic induction agent is an important variable determining the total dose required to reach a given endpoint, such as loss of consciousness (LOC). The influence of infusion rate on the dose-response relationship has not been described rigorously. In this stud...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-08-01 00:00:00
abstract::A carcinogen bioassay of enflurane was performed in Swiss/ICR mice. Two groups of weanling mice, each of 125 males and 125 females, were exposed to eigher a maximum tolerated dose of enflurane, 3000 ppm (0.3 per cent v/v) or compressed air for 4 hs per day, 5 days per week. After 52 weeks exposure, 25 males and 25 fem...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198201000-00003
更新日期:1982-01-01 00:00:00
abstract:BACKGROUND:Some inhalation anesthetics increase apoptotic cell death in the developing brain. Xenon, an inhalation anesthetic, increases neuroprotection when combined with therapeutic hypothermia after hypoxic-ischemic brain injury in newborn animals. The authors, therefore, examined whether there was any neuroapoptoti...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318294934d
更新日期:2013-08-01 00:00:00
abstract::The serum and urinary concentrations of fluorinated metabolites of isoflurane after inhalation of three different concentrations of isoflurane were studied in 18 ASA physical status 1 or 2 patients, scheduled for orthopedic or otolaryngeal surgery. Isoflurane was administered for 60 min during fentanyl-nitrous oxide-o...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract::The cardiovascular effects of halothane-nitrous oxide anesthesia, and beta-receptor blockade with either propranolol or practolol, were studied in 15 dogs in which severe myocardial infarction had been induced ten days earlier. The hemodynamic responses to blood loss amounting to 25 per cent of estimated blood volume,...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197609000-00015
更新日期:1976-09-01 00:00:00