Abstract:
BACKGROUND:Admission hypocalcemia predicts both massive transfusion and mortality in severely injured patients. However, the effect of calcium derangements during resuscitation remains unexplored. We hypothesize that any hypocalcemia or hypercalcemia (either primary or from overcorrection) in the first 24 hours after severe injury is associated with increased mortality. METHODS:All patients at our institution with massive transfusion protocol activation from January 2013 through December 2014 were identified. Patients transferred from another hospital, those not transfused, those with no ionized calcium (Ca) measured, and those who expired in the trauma bay were excluded. Hypocalcemia and hypercalcemia were defined as any level outside the normal range of Ca at our institution (1-1.25 mmol/L). Receiver operator curve analysis was also used to further examine significant thresholds for both hypocalcemia and hypercalcemia. Hospital mortality was compared between groups. Secondary outcomes included advanced cardiovascular life support, damage control surgery, ventilator days, and intensive care unit days. RESULTS:The massive transfusion protocol was activated for 77 patients of whom 36 were excluded leaving 41 for analysis. Hypocalcemia occurred in 35 (85%) patients and hypercalcemia occurred in 9 (22%). Mortality was no different in hypocalcemia versus no hypocalcemia (29% vs 0%; P = .13) but was greater in hypercalcemia versus no hypercalcemia (78% vs 9%; P < .01). Receiver operator curve analysis identified inflection points in mortality outside a Ca range of 0.84 to 1.30 mmol/L. Using these extreme values, 15 (37%) had hypocalcemia with a 60% mortality (vs 4%; P < .01) and 9 (22%) had hypercalcemia with a 78% mortality (vs 9%; P < .01). Patients with extreme hypocalcemia and hypercalcemia also received more red blood cells, plasma, platelets, and calcium repletion. CONCLUSIONS:Hypocalcemia and hypercalcemia occur commonly during the initial resuscitation of severely injured patients. Mild hypocalcemia may be tolerable, but more extreme hypocalcemia and any hypercalcemia should be avoided. Further assessment to define best practice for calcium management during resuscitation is warranted.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
MacKay EJ,Stubna MD,Holena DN,Reilly PM,Seamon MJ,Smith BP,Kaplan LJ,Cannon JWdoi
10.1213/ANE.0000000000002312subject
Has Abstractpub_date
2017-09-01 00:00:00pages
895-901issue
3eissn
0003-2999issn
1526-7598journal_volume
125pub_type
杂志文章abstract::A new single injection procedure, the fascia iliaca compartment block, is described for blocking the femoral, lateral cutaneous, and obturator nerves. The technique consists of injecting a local anesthetic immediately behind the fascia iliaca at the union of the lateral with the two medial thirds of the inguinal ligam...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1989-12-01 00:00:00
abstract::As part of an oximetry research effort in which plethysmographic data were collected from moving patients, a wide variety of patient motion affecting pulse oximetry was observed and characterized by the clinical incidence, type, severity and duration of patient motion. 350 patients were observed for movement in clinic...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
abstract:UNLABELLED:Intraoperative recording of myogenic motor responses evoked by transcranial electrical stimulation (tcMEPs) is a method of assessing the integrity of the motor pathways during aortic surgery. To identify conditions for optimal spinal cord monitoring, we investigated the effects of manipulating the level of n...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-199901000-00005
更新日期:1999-01-01 00:00:00
abstract::In view of the overall experience regarding regional anesthetic techniques to control postoperative pain in infants and children, it is feasible that a similar efficacy and safety profile can be obtained when using such techniques after major orthopedic procedures such as anterior or posterior spinal fusion. I reviewe...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/01.ane.0000107938.80562.75
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:Postoperative sore throat (POST) is a common complication after endotracheal intubation. We compared the effectiveness on POST of spraying the endotracheal tube (ETT) cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. METHODS:Three hundred seventy-two patients were randomly allocated into...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3181d4854e
更新日期:2010-10-01 00:00:00
abstract::Few anesthesia studies have explored perioperative continuous epidural infusion of neostigmine. We examined such a regimen in thoracotomy patients. Ninety patients were randomized to one of three groups in this double-blind trial. Before anesthesia induction, an epidural catheter was inserted in all patients at T5-8 l...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000184812.94185.b3
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Nicotine has an antinociceptive effect in animal models. The analgesic effect in humans has been examined, but studies have had mixed results. A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-hand smoke exposure. In this study, we exam...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3181bd1612
更新日期:2009-12-01 00:00:00
abstract::This study was performed to compare the efficacy of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting (PONV) and to compare the possible adverse effects of these drugs in gynecologic incontinence surgery. Using a randomized, double-blind study design, we studied 150 women under...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199703000-00036
更新日期:1997-03-01 00:00:00
abstract::Our aim was to determine how isoflurane modified crossbridge (CB) number and kinetics in airway smooth muscle (ASM) and to compare its effects in Fisher and Lewis rats, two strains with differences in airway responsiveness. The effects of isoflurane (2 MAC) on isotonic and isometric contractility in tracheal ASM strip...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000152644.44927.E4
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Postoperative delirium is an important problem for surgical inpatients and was the target of a multidisciplinary quality improvement project at our institution. We developed and tested a semiautomated delirium risk stratification instrument, Age, WORLD backwards, Orientation, iLlness severity, Surgery-specif...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000005085
更新日期:2020-12-01 00:00:00
abstract::Previous studies have shown that bolus doses of fentanyl (50 and 100 micrograms) with epidural bupivacaine delay gastric emptying by up to 45 min. We studied the effect of the addition of small-dose fentanyl to epidural bupivacaine infusions on gastric emptying during labor. The acetaminophen absorption technique was ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199603000-00032
更新日期:1996-03-01 00:00:00
abstract:UNLABELLED:Cryoanalgesia versus sham treatment was applied to the ilioinguinal and iliohypogastric nerves after mesh repair of an inguinal hernia under local anesthesia in 48 male patients in a prospective, randomized, and observer- and patient-blinded trial. Pain was scored daily during rest, while coughing, and durin...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199810000-00028
更新日期:1998-10-01 00:00:00
abstract:UNLABELLED:I designed this study to determine the efficacy of heart rate (HR), systolic blood pressure (SBP), and digital skin blood flow (DSBF) in detecting intravascular injection after a simulated epidural test dose containing 15 mug of epinephrine in sevoflurane-anesthetized adults. In addition, the testing thresho...
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.0000157571.00717.08
更新日期:2005-08-01 00:00:00
abstract:IMPLICATIONS:Tizanidine was given systemically to rats with experimental postoperative pain. Partial pain relief was obtained, but the effect was not clinically significant. Although systemic tizanidine is effective in relieving experimental neuropathic pain, it is not as effective for postoperative pain. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200111000-00056
更新日期:2001-11-01 00:00:00
abstract::The contribution of the lung to the clearance of exogenous dopamine after cardiopulmonary bypass (CPB) was analyzed quantitatively in humans and compared with the contribution of the lung before CPB. The pulmonary and arterial plasma concentration of dopamine and the pulmonary plasma flow were measured simultaneously ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199301000-00019
更新日期:1993-01-01 00:00:00
abstract::The effects of halothane and enflurane anesthesia under conditions of normo-, hyper-, and hypocarbia on the autoregulation of cerebral blood flow (CBF) in the goat were evaluated. The goat was selected because of its unique arterial blood supply to the head and the development of a method by which CBF may be continuou...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197601000-00024
更新日期:1976-01-01 00:00:00
abstract::Perioperative thermal manipulations are usually directed at the skin surface because methods of directly warming the core are invasive or ineffective. However, inadequate heat flow between peripheral and core compartments will decrease the rate at which core temperature changes. We therefore determined whether core hy...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199605000-00006
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:The recommended treatment of suspected tension pneumothorax is immediate needle decompression. Recommended sites and needle sizes for this procedure vary, and there are published reports of failed decompression as well as iatrogenic hemothorax. We investigated the optimal needle length and relative safety of...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000282827.86345.ff
更新日期:2007-11-01 00:00:00
abstract::Although clonidine has been shown to increase the duration of local anesthetic action and prolong postoperative analgesia when included in single-injection nerve blocks, a controlled investigation of the efficacy of this practice to improve analgesia for continuous perineural local anesthetic infusion has not been rep...
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.0000075840.52964.a7
更新日期:2003-09-01 00:00:00
abstract:UNLABELLED:Fentanyl reduces the amount of propofol necessary to prevent responses to surgical stimuli. However, opioids have relatively little effect on consciousness. We, therefore, tested the hypothesis that fentanyl minimally alters the effect-site concentration of propofol associated with awakening. Fifty women hav...
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.0000062772.28479.2b
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:Transporting patients under anesthesia care incurs numerous potential risks, especially for those with critical illness. The purpose of this study is to identify and report all pediatric anesthesia transport-associated adverse events from a preexisting database of perioperative adverse events. METHODS:An ex...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000004433
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Thoracic aorta dissection is an acute critical condition associated with shock-induced endotheliopathy, coagulopathy, massive bleeding, and significant morbidity and mortality. Our aim was to compare the effect of coagulation support with solvent/detergent-treated pooled plasma (OctaplasLG) versus standard f...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003545
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Previous studies show that the potent, prototypical sigma(1)-receptor agonist 4-phenyl-1-(4-phenylbutyl) piperidine (PPBP) prevents cell death after oxygen-glucose deprivation (OGD) in primary cortical neuronal cultures. We tested the hypothesis that PPBP protects neurons by a mechanism involving activation ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318192442c
更新日期:2009-03-01 00:00:00
abstract::Complement activation and the resulting inflammatory response is an important potential mechanism for multisystem organ injury in cardiac surgery. Novel therapeutic strategies using complement inhibitors may hold promise for improving outcomes for cardiac surgical patients by attenuating complement activation or its b...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e3182652b7d
更新日期:2012-10-01 00:00:00
abstract::We tested whether anesthesia that includes nitrous oxide (N2O) results in the development of intraoperative and postoperative pulmonary complications, including hypoxemia. We also tested whether aging contributes to the development of such complications, particularly when anesthesia includes N2O. We randomly allocated...
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:1990-12-01 00:00:00
abstract:BACKGROUND:Noticeable changes in vital signs indicating hypovolemia occur only after 15% of the blood volume is lost. More sensitive variables (e.g., cardiac output, systolic pressure variation and its Δdown component) are invasive and difficult to obtain in the early phase of bleeding. Lately, a new technology for con...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31820ad4ef
更新日期:2011-03-01 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::An in-vitro experiment demonstrated the concentration effect of N2O (3% versus 75%) during elimination and during uptake. Other pulmonary absorption-excretion phenomena also occur simultaneously, as paired events during uptake and then during elimination:diffusion hyperoxia and diffusion anoxia; alveolar concentration...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197601000-00013
更新日期:1976-01-01 00:00:00
abstract:BACKGROUND:Sedatives and analgesics, in doses that alter consciousness in the intensive care unit (ICU), contribute to delirium and mortality. Pain, agitation, and delirium can be monitored in ICU patients. These symptoms were noted before (PRE) and after (POST) a protocol to alleviate undesirable symptoms. Analgesia a...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181d7e1b8
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:We studied the effects that the lung recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) have on the elimination of CO(2) per breath (Vtco(2,br)). METHODS:In 7 healthy and 7 lung-lavaged pigs at constant ventilation, PEEP was increased from 0 to 18 cm H(2)O and then decreased to 0 in steps...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181f0c2da
更新日期:2010-10-01 00:00:00