Abstract:
:Prothrombin complex concentrates (PCCs) contain vitamin K-dependent clotting factors (II, VII, IX, and X) and are marketed as 3 or 4 factor-PCC formulations depending on the concentrations of factor VII. PCCs rapidly restore deficient coagulation factor concentrations to achieve hemostasis, but like with all procoagulants, the effect is balanced against thromboembolic risk. The latter is dependent on both the dose of PCCs and the individual patient prothrombotic predisposition. PCCs are approved by the US Food and Drug Administration for the reversal of vitamin K antagonists in the setting of coagulopathy or bleeding and, therefore, can be administered when urgent surgery is required in patients taking warfarin. However, there is growing experience with the off-label use of PCCs to treat patients with surgical coagulopathic bleeding. Despite their increasing use, there are limited prospective data related to the safety, efficacy, and dosing of PCCs for this indication. PCC administration in the perioperative setting may be tailored to the individual patient based on the laboratory and clinical variables, including point-of-care coagulation testing, to balance hemostatic benefits while minimizing the prothrombotic risk. Importantly, in patients with perioperative bleeding, other considerations should include treating additional sources of coagulopathy such as hypofibrinogenemia, thrombocytopenia, and platelet disorders or surgical sources of bleeding. Thromboembolic risk from excessive PCC dosing may be present well into the postoperative period after hemostasis is achieved owing to the relatively long half-life of prothrombin (factor II, 60-72 hours). The integration of PCCs into comprehensive perioperative coagulation treatment algorithms for refractory bleeding is increasingly reported, but further studies are needed to better evaluate the safe and effective administration of these factor concentrates.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Ghadimi K,Levy JH,Welsby IJdoi
10.1213/ANE.0000000000001188subject
Has Abstractpub_date
2016-05-01 00:00:00pages
1287-300issue
5eissn
0003-2999issn
1526-7598journal_volume
122pub_type
杂志文章,评审abstract:UNLABELLED:We performed this study to assess the safety of immediate extubation after elective abdominal aortic aneurysm surgery. Consecutive patients were prospectively randomized into two groups after surgery: Group 1 (n = 29) immediate extubation; and Group 2 (n = 21) delayed (at least 4 h) extubation. All patients ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200112000-00044
更新日期:2001-12-01 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:BACKGROUND:Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003666
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Oral opioid formulations contribute to postoperative analgesia. In this study, we evaluated the perioperative application of oral controlled-release oxycodone to reduce postoperative IV morphine consumption and opioid side effects after lumbar discectomy. METHODS:Forty patients scheduled for elective lumbar...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000266451.77524.0d
更新日期:2007-07-01 00:00:00
abstract:UNLABELLED:We designed this study to assess the efficacy of dolasetron compared with clonidine and placebo in prophylaxis of postanesthetic shivering. We included 90 patients undergoing elective abdominal or urologic surgery. The patients were randomly assigned to one three groups (each group n = 30) using a double-bli...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验,收录出版
doi:10.1097/00000539-200201000-00020
更新日期:2002-01-01 00:00:00
abstract::The effect of isoflurane on regional myocardial metabolism and blood flow, when used as an adjunct to fentanyl-nitrous oxide anesthesia, to control intraoperative hypertension was investigated. Twenty-two patients with two- or three-vessel coronary artery disease with an ejection fraction greater than 0.5 and on beta-...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-198902000-00006
更新日期:1989-02-01 00:00:00
abstract::Catecholamine-induced desensitization of beta-adrenergic receptors resulting in hyporesponsiveness to further stimulation has been frequently reported after an increase in endogenous catecholamines. To examine the possibility of beta-adrenoceptor desensitization due to intraoperative adrenergic activation (surgical st...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199007000-00001
更新日期:1990-07-01 00:00:00
abstract:UNLABELLED:We assessed the sedative potential of continuous infusions of remifentanil with a validated composite alertness scale in 160 patients (ASA physical status I or II) undergoing hip replacement surgery with spinal block (n = 61) or hand surgery using brachial plexus block (n = 93). They were randomized to recei...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199901000-00025
更新日期:1999-01-01 00:00:00
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
doi:
更新日期:1984-12-01 00:00:00
abstract:UNLABELLED:Because anesthetic technique has the potential to dramatically affect cerebral blood flow and metabolism (two determinants of brain thermoregulation), we tested the hypothesis that, after craniotomy, anesthetic technique would influence brain temperature independent of core temperature. Twenty-one cats (2.7 ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000061221.23197.ce
更新日期:2003-05-01 00:00:00
abstract::The hemodynamic effects of mivacurium chloride were studied in 54 adult cardiac patients anesthetized with midazolam and sufentanil. After baseline data were collected, a placebo (N = 9) or mivacurium was administered over 60 seconds, the latter in doses of 0.15 (N = 18), 0.20 (N = 18), or 0.25 (N = 9) mg/kg. Measurem...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:
更新日期:1989-03-01 00:00:00
abstract:BACKGROUND:The primary objective of this study was to compare the characteristics of culture-positive and culture-negative status in septic patients. We also determined whether culture status is associated with mortality and whether unique variables are associated with mortality in culture-positive and culture-negative...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000004072
更新日期:2019-11-01 00:00:00
abstract:UNLABELLED:In this study, we compared the direct myocardial depressant effects of sevoflurane, isoflurane, and halothane and determined whether an L-type Ca2+ channel agonist, Bay K 8644, could attenuate the myocardial depression induced by these anesthetics in cultured neonatal rat ventricular myocytes. Ventricular my...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199811000-00013
更新日期:1998-11-01 00:00:00
abstract::We investigated the incidence of transient neurologic symptoms (TNS) after the use of hyperbaric lidocaine as compared with hyperbaric bupivacaine in patients undergoing cesarean delivery under spinal anesthesia. Two hundred women scheduled for cesarean delivery were randomly allocated to receive spinal anesthesia wit...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200102000-00023
更新日期:2001-02-01 00:00:00
abstract::The understanding of anesthetic side effects on the heart has been hindered by the lack of sophisticated clinical models. Using micropatterned human-induced pluripotent stem cell-derived cardiomyocytes, we obtained cardiac muscle depressant profiles for propofol, etomidate, and our newly identified anesthetic compound...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003757
更新日期:2020-01-01 00:00:00
abstract::Enhanced recovery after surgery (ERAS) has rapidly gained popularity in a variety of surgical subspecialities. A large body of literature suggests that ERAS leads to superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost benefits, without affecting rates of readmission after surger...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000003564
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Short-term case cancellation causes frustration for anesthesiologists, surgeons, and patients and leads to suboptimal use of operating room (OR) resources. In many facilities, >10% of all cases are cancelled on the day of surgery, thereby causing major problems for OR management and anesthesia departments. T...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0b013e318222be4d
更新日期:2011-09-01 00:00:00
abstract:UNLABELLED:In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA; Laboratorie ASTRA, Manterre, France) with subcutaneous local lidocaine infiltration for radial artery cannulation. Patients included 538 adults scheduled for coronary angiography using a radial approach. EMLA was app...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199808000-00032
更新日期:1998-08-01 00:00:00
abstract:UNLABELLED:A microscope will be used for the first case of the day in operating room (OR) 1 and then may be used in the second case of the day by a different surgeon in a different OR, OR 2. Provided that the probability is reasonably high that the first case of the day in OR 2 will last longer than the first case in O...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200004000-00037
更新日期:2000-04-01 00:00:00
abstract::Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (Fio2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tis...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000229715.71464.90
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Hypothermia may be accidental or therapeutic. Therapeutic hypothermia is increasingly used as treatment for various conditions, e.g., neuroprotection after cardiac arrest. Hypothermia leads to an impairment of the coagulation system, but the degree of impairment has been difficult to determine. Most studies ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31817ee955
更新日期:2008-11-01 00:00:00
abstract::Virchow's triad is traditionally invoked to explain pathophysiologic mechanisms leading to thrombosis, alleging concerted roles for abnormalities in blood composition, vessel wall components, and blood flow in the development of arterial and venous thrombosis. Given the tissue-specific bleeding observed in hemophilia ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e31823a088c
更新日期:2012-02-01 00:00:00
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
doi:
更新日期:1984-08-01 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::The anesthetic propofol (2,6 diisopropylphenol) mediates some of its effects by activating inhibitory chloride currents in the lower brainstem and spinal cord. The effects comprise direct activation of gamma-aminobutyric acid-A and glycine receptors in the absence of the natural agonist, as well as potentiation of the...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000120083.10269.54
更新日期:2004-07-01 00:00:00
abstract::We designed a randomized, double-blind study to assess the analgesic efficacy and safety of perioperative ketorolac infusion in 95 patients undergoing cholecystectomy. The ketorolac group (n = 48) received premedication, combined with ketorolac 30 mg intramuscularly (IM), followed by a ketorolac continuous infusion (2...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199403000-00017
更新日期:1994-03-01 00:00:00
abstract::Although the pathogenesis of acute renal injury after cardiac surgery is multifactorial, atherosclerosis of the ascending aorta and embolic burden are strong independent predictors. Use of the Symmetry aortic connector device (ACD) for proximal anastomosis of coronary grafts may reduce ascending aortic atheroembolism....
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000189054.17725.73
更新日期:2006-01-01 00:00:00
abstract::Alfentanil, a short-acting lipophilic opioid, is used for labor analgesia and cesarean section and may cause neonatal depression. However, direct placental alfentanil transfer has not been studied. We measured placental alfentanil transfer and uptake during in vitro perfusion. Placenta lobules from healthy parturients...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199412000-00011
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle calcium regulation associated primarily, but not exclusively, with mutations in the skeletal muscle ryanodine receptor. Associated environmental factors, however, may also be important for expression of the syndrome. METHODS AND RE...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31819240a5
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis. It has be...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3181ba7945
更新日期:2009-11-01 00:00:00