Abstract:
BACKGROUND:Although rotational thromboelastometry (ROTEM) is increasingly used to guide haemostatic therapy in a bleeding patient, there is a paucity of data guiding its use in the paediatric population. OBJECTIVE:The objective of this study is to develop an algorithm on the basis of ROTEM values obtained in our paediatric cardiac population to guide the management of the bleeding child. DESIGN:A retrospective analysis. SETTING:Department of Anaesthesiology, Queen Fabiola Children's University Hospital. Data were collected between September 2010 and January 2012. PATIENTS:All children who underwent elective cardiac surgery requiring cardiopulmonary bypass (CPB) were reviewed. INTERVENTION:None. MAIN OUTCOME MEASURES:Significant postoperative bleeding was defined as blood loss more than 10% of the child's estimated blood volume within the first six postoperative hours, dividing our population according to high blood loss (HBL) or low blood loss (LBL). Factors independently associated with postoperative bleeding determined the bleeding probability. Receiving operating characteristics (ROC) curves were constructed with the aim of determining relevant ROTEM parameters (including clot amplitude 10 min after administration of protamine [A10]) to be used in our algorithm. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined for the developed algorithm. RESULTS:One-hundred and fifty children were included in our study. Univariate and multivariate logistic regression analysis revealed that preoperative weight (kg), presence of a cyanotic disease (yes/no) and wound closure duration (min) were independent predictors of postoperative bleeding. Analysis of our ROTEM parameters revealed that clotting time (CT) ≥ 111 s, A10 ≤ 38 mm measured on the EXTEM and A10 ≤ 3 mm obtained on the FIBTEM tests were the three relevant parameters to guide haemostatic therapy. If the ROTEM-based algorithm was applied according to the bleeding risk (n = 65), 27 out of 29 of the HBL and 24 out of 36 of the LBL group would have been treated. CONCLUSION:This study describes an algorithm starting with the detection of abnormal bleeding in which ROTEM could be used to guide haemostatic therapy in bleeding children after CPB. Further studies are needed to test the efficacy of this specific algorithm-based approach.
journal_name
Eur J Anaesthesioljournal_title
European journal of anaesthesiologyauthors
Faraoni D,Willems A,Romlin BS,Belisle S,Van der Linden Pdoi
10.1097/EJA.0000000000000179subject
Has Abstractpub_date
2015-05-01 00:00:00pages
320-9issue
5eissn
0265-0215issn
1365-2346journal_volume
32pub_type
杂志文章abstract:BACKGROUND AND OBJECTIVE:To evaluate the efficacy of 0.1% ropivacaine with fentanyl 2 microg mL(-1) via epidural for analgesia in labour. METHODS:In a randomized study, 80 nulliparous parturients in labour had epidural analgesia initiated with 0.2% ropivacaine and fentanyl and were then randomized to receive either 0....
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1017/s0265021504000031
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:Postoperative cognitive decline (pCD) occurs frequently (6 to 30%) after carotid endarterectomy (CEA), although there are no exact estimates and risk factors are still unclear. OBJECTIVE:The objective of this study was to determine pCD incidence and risk factors in CEA patients. DESIGN:We performed a syste...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
doi:10.1097/EJA.0000000000001130
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abstract:CONTEXT:The single-use Laryngeal Mask Airway (LMA) Supreme is a new supraglottic airway device. It has been reported to be reliable and easy-to-use in clinical practice; however, the anaesthetic techniques for its insertion are not standardised. OBJECTIVES:The purpose of this study was to determine the ED50 of end-tid...
journal_title:European journal of anaesthesiology
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doi:10.1097/EJA.0b013e32835c5512
更新日期:2013-04-01 00:00:00
abstract::The effect of the administration of a 50 mg dose of an angiotensin converting enzyme inhibitor (captopril) on the mean arterial pressure following sternotomy in 13 patients undergoing coronary artery bypass surgery was indistinguishable from the response in 13 patients who had not received the drug. ...
journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
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abstract:BACKGROUND:The creation of pneumoperitoneum during laparoscopic surgery can lead to adverse effects on the respiratory system. Positive end-expiratory pressure (PEEP) plays an important role in mechanical ventilation during laparoscopic surgery. OBJECTIVE:To evaluate whether PEEP setting guided by oesophageal pressure...
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journal_title:European journal of anaesthesiology
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journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章
doi:10.1046/j.1365-2346.1994.00172.x
更新日期:1997-11-01 00:00:00
abstract:INTRODUCTION:We tested the hypothesis that repeated autoclaving removes protein deposits from the classic laryngeal mask airway (LMA). METHODS:Twenty previously used LMAs were hand washed, machine washed, dried, autoclaved and randomly allocated into four equal-sized groups for repeat autoclaving on 0 (control), 1, 2 ...
journal_title:European journal of anaesthesiology
pub_type: 杂志文章
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journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:European journal of anaesthesiology
pub_type: 杂志文章
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abstract::Malignant hyperthermia is an autosomal-dominant inherited disorder of the skeletal muscle cell characterized by a hypermetabolic response to all commonly used inhalational anaesthetics and depolarizing muscle relaxants. The clinical syndrome includes muscle rigidity, hypercapnia, tachycardia and myoglobinuria as resul...
journal_title:European journal of anaesthesiology
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更新日期:2001-10-01 00:00:00
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journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2000-03-01 00:00:00
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journal_title:European journal of anaesthesiology
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更新日期:2017-08-01 00:00:00
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journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1017/s0265021503001571
更新日期:2003-12-01 00:00:00
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journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1987-11-01 00:00:00
abstract::We describe the case of a 36-year-old woman, with a previous history of recurrent abortion due to protein S deficiency, undergoing an elective Caesarean section at 39-weeks gestation. During pregnancy no signs of hypertension or cardiovascular disease were reported, but at the end of the surgical procedure, the patien...
journal_title:European journal of anaesthesiology
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journal_title:European journal of anaesthesiology
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journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:European journal of anaesthesiology
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journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2021-01-04 00:00:00
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journal_title:European journal of anaesthesiology
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journal_title:European journal of anaesthesiology
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journal_title:European journal of anaesthesiology
pub_type: 杂志文章,评审
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更新日期:2010-11-01 00:00:00
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journal_title:European journal of anaesthesiology
pub_type: 临床试验,杂志文章
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更新日期:2006-01-01 00:00:00
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journal_title:European journal of anaesthesiology
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更新日期:2007-02-01 00:00:00