Abstract:
BACKGROUND:Neonates undergoing cardiac surgery are especially prone to the hemostatic alterations of cardiopulmonary bypass (CPB) and are at high risk for post-CPB bleeding. An immature coagulation system, significant hemodilution from the CPB prime, long CPB times at low temperatures, and extensive suture lines increase neonates' susceptibility to bleeding after CPB. In this study, we examined the relationship between excessive bleeding in neonates after CPB and major postoperative adverse events. METHODS:We retrospectively reviewed the medical records of 169 neonates who underwent complex congenital heart surgery with CPB between January 1, 2010, and December 31, 2011. Perioperative data were collected and analyzed with specific focus on post-CPB bleeding as measured by 24-hour postoperative chest tube output (CTO), post-CPB transfusion requirements, and major postoperative adverse events, including renal dysfunction, dialysis, thrombosis, extracorporeal membrane oxygenation (ECMO), and in-hospital mortality. We used Spearman correlation to determine correlations between multiple perioperative variables and 24-hour CTO and postoperative blood product requirements. Also, we used logistic regression analysis to determine the association between excessive bleeding (defined as 24-hour CTO >75th percentile) and major postoperative adverse events. RESULTS:Significant correlations were found between 24-hour CTO and postoperative blood product transfusion with weight, Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, CPB time, and lowest temperature. Logistic regression found that excessive bleeding after CPB was an independent predictor of postoperative dialysis (relative risk [RR] 12.0; confidence interval, 1.50-54.69; P = 0.02) and ECMO (RR 9.95; confidence interval, 3.07-28.47; P = 0.0008). RACHS-1 score was a significant predictor of in-hospital mortality (P = 0.03). CONCLUSIONS:Excessive postoperative bleeding in neonates after CPB is independently associated with increased adverse events, specifically the need for postoperative dialysis and ECMO support. Our findings in neonates are congruent with other recent research that also has found increasing transfusion requirements after pediatric CPB to be independently associated with an increase in major postoperative adverse events. Our results may aid clinicians in anticipating potential adverse events after neonatal bypass and in allocating the resources necessary to manage these events.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Guzzetta NA,Allen NN,Wilson EC,Foster GS,Ehrlich AC,Miller BEdoi
10.1213/ANE.0000000000000531subject
Has Abstractpub_date
2015-02-01 00:00:00pages
405-10issue
2eissn
0003-2999issn
1526-7598journal_volume
120pub_type
杂志文章abstract::We investigated the anesthetic and analgesic effectiveness of adding dexamethasone to lidocaine for IV regional anesthesia (IVRA). Seventy-five patients undergoing ambulatory hand surgery were randomly assigned to one of three groups: group L received 3 mg/kg lidocaine, group LD received 3 mg/kg lidocaine + 8 mg dexam...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000194944.54073.dd
更新日期:2006-02-01 00:00:00
abstract:UNLABELLED:The aim of this study was to investigate modern and classical electroencephalographic (EEG) variables in response to remifentanil and propofol infusions. We hypothesized that modern EEG variables may indicate the effects of propofol but not of remifentanil. Twenty-five patients were included in the study aft...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200211000-00042
更新日期:2002-11-01 00:00:00
abstract::Halothane, enflurane, isoflurane, and fentanyl were examined for their potential to exacerbate liver dysfunction in rats with preexisting cirrhosis. Male Wistar rats given sodium phenobarbital for 2 weeks are assigned randomly to two groups. One group (cirrhotic) was exposed by inhalation to carbon tetrachloride (CCl4...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1985-12-01 00:00:00
abstract:BACKGROUND:Preoperative flushing of an anesthesia workstation is an alternative for preparation of the anesthesia workstation before use in malignant hyperthermia-susceptible patients (MHS). We studied in vitro, using a test lung, the washout profile of sevoflurane in 7 recent workstations during adult and, for the fir...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000208
更新日期:2014-07-01 00:00:00
abstract:UNLABELLED:The last decade has witnessed a proliferation of devices or methods that facilitate intubation in difficult circumstances, maintain ventilation, or which do both. These all require properly functioning and specially designed apparatus, the use of which requires variable degrees of expertise. This technical c...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200202000-00045
更新日期:2002-02-01 00:00:00
abstract:UNLABELLED:In this study, we examined the effectiveness of caudal blocks and correlated it with the laxity of the patients' anal sphincter before emergence from anesthesia in 178 children undergoing inguinal and/or penile surgery. Bupivacaine 0.25% in a volume of 0.6-1.25 mL/kg was used in all patients. The presence of...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200205000-00019
更新日期:2002-05-01 00:00:00
abstract:UNLABELLED:Intravenous and volatile general anesthetics inhibit norepinephrine (NE) release from sympathetic neurons and other neurosecretory cells. However, the actions of general anesthetics on NE release from central nervous system (CNS) neurons are unclear. We investigated the effects of representative IV and volat...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200211000-00032
更新日期:2002-11-01 00:00:00
abstract::The tandem pore domain K channel family mediates background K currents present in excitable cells. Currents passed by certain members of the family are enhanced by volatile anesthetics, thus suggesting a novel mechanism of anesthesia. The newest member of the family, termed TRESK (TWIK [tandem pore domain weak inward ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000136849.07384.44
更新日期:2004-12-01 00:00:00
abstract:UNLABELLED:Combined spinal-epidural anesthesia (CSE) is a popular technique for cesarean delivery. Regional blocks in obstetrics are often performed with the parturient in the sitting position because the midline may be recognized more easily than in the lateral decubitus position. When conventional spinal anesthesia i...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199809000-00023
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:There are three basic types of decision aids to facilitate operating room (OR) management decision-making on the day of surgery. Decision makers can rely on passive status displays (e.g., big screens or whiteboards), active status displays (e.g., text pager notification), and/or command displays (e.g., text ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000268539.85847.c9
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:In this study, we sought to determine whether a simplified ultrasound measurement of the largest transverse diameter, using a standard ultrasound machine, could be used to diagnose postoperative urinary retention (POUR). This method may replace expensive bladder volume measuring devices or a more complex ult...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/ANE.0000000000000595
更新日期:2015-05-01 00:00:00
abstract::We compared intrathecal ropivacaine to bupivacaine in patients scheduled for transurethral resection of bladder or prostate. Doses of ropivacaine and bupivacaine were chosen according to a 3:2 ratio found to be equipotent in orthopedic surgery. One hundred patients were randomly assigned to blindly receive either 10 m...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200012000-00030
更新日期:2000-12-01 00:00:00
abstract:UNLABELLED:Several factors are responsible for hypercarbia during laparoscopic procedures. This study was undertaken because we observed a sudden increase in PaCO(2) in children with portal hypertension (PHT), which was unusual in healthy children undergoing laparoscopic procedures. Fifty-seven children underwent lapar...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200211000-00022
更新日期:2002-11-01 00:00:00
abstract:UNLABELLED:Children undergoing placement of bilateral myringotomy tubes (BMT) often exhibit pain-related behavior (agitation) in the postanesthesia care unit. We compared the emergence and recovery profiles of pediatric patients who received sevoflurane with or without supplementary intranasal fentanyl for BMT surgery....
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200105000-00016
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:We compared temperature changes in patients undergoing hip replacement during warming with a resistive heating blanket or air-forced system. METHODS:Fifty-six patients were enrolled. Patients were randomly allocated to the "forced-air group" (forced-air system) or to the "heating-blanket group" (resistive h...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e31818e6199
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Heart rate variability might predict arrhythmias after coronary artery bypass grafting. METHODS:Off-line processing of 10-min electrocardiogram recordings of consecutive patients provided R-R intervals for time domain, frequency domain, Poincaré, and point correlation analyses and subsequent association wit...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000239330.45658.76
更新日期:2006-11-01 00:00:00
abstract:IMPLICATIONS:Chronic hiccups may be a serious therapeutic problem. Pharmacological treatment with increasing dosages of baclofen, carbamazepine, or gabapentin is not always successful. In this paper, the use of general anesthesia with positive-pressure ventilation and muscle relaxation for the termination of chronic hi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200208000-00050
更新日期:2002-08-01 00:00:00
abstract:UNLABELLED:We describe the development and evaluation of a simple slide rule that enables the bedside determination of the infusion rate for a particular target plasma concentration of propofol. The infusion rate to reach this target concentration at time (t) is the product of the target concentration, body weight, and...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200301000-00029
更新日期:2003-01-01 00:00:00
abstract::The ability of opiates to be a complete anesthetic has been assessed in animals. These studies have investigated the serum levels of opiate required to produce a decrease in anesthetic requirement for a concomitantly administered inhalation anesthetic. A linear dose-response relation has been observed between opiate s...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1988-07-01 00:00:00
abstract:UNLABELLED:Numerous clinical studies suggest that methylprednisolone may facilitate early tracheal extubation after cardiac surgery, yet no investigation has rigorously examined the use of the drug in this setting. In this prospective, randomized, double-blind, placebo-controlled study, we examined the pulmonary effect...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199807000-00007
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:Animal models show us that specific activation of the p38 mitogen-activated protein kinase (MAPK) may be a pivotal step in lidocaine neurotoxicity, but this has not been investigated in the case of two very widely used local anesthetics, bupivacaine and ropivacaine. We investigated the hypotheses that these ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318168514b
更新日期:2008-05-01 00:00:00
abstract::The purpose of this study was to evaluate the influence of the volume of methylene blue-local anesthetic on the spread of the injectate along the costal pleura. Twenty patients undergoing elective thoracotomy were studied. Twelve patients received intercostal nerve injection with 10 mL of 0.5% bupivacaine with methyle...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199209000-00013
更新日期:1992-09-01 00:00:00
abstract:UNLABELLED:Despite clinical and laboratory evidence of perioperative hypercoagulability, there are no consistent data evaluating the extent, duration, and specific contribution of platelets and procoagulatory proteins by in vitro testing. We tested the hypothesis that the parallel use of standard and abciximab-cytochal...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200103000-00004
更新日期:2001-03-01 00:00:00
abstract:BACKGROUND:Performing key actions efficiently during crises can determine clinical outcomes, yet even expert clinicians omit key actions. Simulation-based studies of crises show that correct performance of key actions dramatically increases when emergency manuals (EMs) are used. Despite widespread dissemination of EMs,...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000005012
更新日期:2020-12-01 00:00:00
abstract::To compare the dose-response of remifentanil for tracheal intubation in infants and children, 32 healthy full-term infants and 32 children were anesthetized with 10 mug/kg glycopyrrolate and 4.0 mg/kg propofol and administered 1 of 4 doses of remifentanil (1.25, 1.50, 1.75, or 2.00 microg/kg) to facilitate tracheal in...
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.0000150940.57369.B5
更新日期:2005-06-01 00:00:00
abstract::We studied the effect of large-dose intrathecal sufentanil (ITS) for major abdominal surgery on the hormonal stress response. Forty patients were randomly allocated to receive either IV sufentanil (IVS) or 150 microg of ITS as part of general anesthesia. In the IVS group, adrenocorticotropic hormone (ACTH) and cortiso...
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.0000131728.68125.4E
更新日期:2004-10-01 00:00:00
abstract::The number of anesthesiology residents pursuing critical care medicine (CCM) fellowship training has been decreasing in recent years. A significant number of training positions remain unfilled each year. Possible causes of this decline were evaluated by surveying residents regarding their attitudes toward practice and...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199309000-00002
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:The presence of an endotracheal tube is the main cause for developing ventilator-associated pneumonia (VAP), but pneumonia can still develop in hospitalized patients after endotracheal tube removal (postextubation pneumonia [PEP]). We hypothesized that short-term intubation (24 hours) can play a role in the ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001899
更新日期:2017-04-01 00:00:00
abstract:UNLABELLED:Nitric oxide (NO) may play an important role in central and peripheral nociceptive processes. However, its contribution to peripheral antinociception is still not clear. In the present study, we investigated the effect of peripherally administered FK409, a spontaneous NO releaser, and its interaction with pe...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199802000-00028
更新日期:1998-02-01 00:00:00
abstract:BACKGROUND:Our primary objective was to investigate the effects of three different endotracheal suctioning procedures on functional residual capacity (FRC). METHODS:Using a crossover design, postoperative cardiac surgery patients (n = 20) received three different suctioning methods in randomized order: closed suctioni...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e3181804a5d
更新日期:2008-09-01 00:00:00