Abstract:
BACKGROUND:An important cause of coagulopathy in cardiac surgery is impaired thrombin generation. While plasma is often used to correct this element of the coagulopathy, studies in vitro suggest that prothrombin complex concentrates (PCCs) might be more effective. Comparative data, however, are scant. METHODS:We compared the outcomes of those who received only plasma with those who received PCCs (with or without plasma) for management of coagulopathy in patients who underwent cardiac surgery with cardiopulmonary bypass at a single institution from 2012 to 2016. Propensity score matching was used to obtain between-group balance. Primary outcome was avoidance of perioperative red cell transfusions. Other outcomes were incidence of massive transfusion (more than nine red cell units), refractory bleeding (requiring factor VIIa), and adverse events. RESULTS:Of 6362 patients, 1151 (18.2%) received plasma without any PCCs, and 204 (3.2%) received PCCs, either with (n=125) or without plasma (n=79). Overall, patient risk-profile was higher in the PCCs group. In a well-balanced propensity score match that included 117 patients per group, the odds ratio (OR) for red cell avoidance was 2.4-fold [95% confidence interval (CI) 1.2-4.8] higher in the PCCs group. Massive transfusion (OR 0.58; 95% CI 0.33-1.0) and refractory bleeding (OR 0.49; 95% CI 0.24-1.03) incidences were almost significantly lower in the PCCs group. The adverse event profiles were similar. CONCLUSIONS:Our exploratory study suggests that the use of PCCs as part of a multifaceted coagulation management strategy may have blood-sparing effects. Their incorporation into clinical practice, however, must await determination of their risk-benefit profile via multicentre randomised trials.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Fitzgerald J,Lenihan M,Callum J,McCluskey SA,Srinivas C,van Rensburg A,Karkouti Kdoi
10.1016/j.bja.2018.02.017subject
Has Abstractpub_date
2018-05-01 00:00:00pages
928-934issue
5eissn
0007-0912issn
1471-6771pii
S0007-0912(18)30126-0journal_volume
120pub_type
杂志文章abstract::A simple method of adapting a pressure-cycled ventilator of the flow generator type to ventilate patients on a circle-absorber anaesthetic system is described. Standard lengths of corrugated black rubber tubing are placed between the ventilator and the circle-absorber is deadspace, replacing the reservoir bag. The per...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/49.3.273
更新日期:1977-03-01 00:00:00
abstract::Systolic pressure variation (SPV) and its dDown component have been shown to be sensitive factors in estimating intravascular volume in patients undergoing mechanical ventilation. In this study, ventilation-induced changes in pulse oximeter plethysmographic waveform were evaluated after removal and after reinfusion of...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/82.2.178
更新日期:1999-02-01 00:00:00
abstract::We have studied the pharmacokinetics of lignocaine in children after local infiltration for cleft palate surgery. After induction of anaesthesia, lignocaine 2.5 mg kg-1 with adrenaline 1:200,000 was injected into the palate. Blood samples were collected before and at 2, 5, 10, 15, 20, 30, 60 and 120 min after infiltra...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/69.6.577
更新日期:1992-12-01 00:00:00
abstract::We report the anaesthetic management of a male neonate with congenital cyst adenoid malformation (CCAM) of the lung who underwent thoracotomy for resection of CCAM 24 h after birth and again at 24 days. The initial operation involved a 10-day admission to a paediatric intensive care unit (PICU) requiring ventilation, ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aei171
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:Balloon dilatational tracheostomy using the Ciaglia Blue Dolphin device has recently been introduced as a modification of the Ciaglia technique. The aim of this study was to compare the new Dolphin system with the single-step dilatational tracheostomy (Ciaglia Blue Rhino) in intensive care unit (ICU) patient...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aeq087
更新日期:2010-06-01 00:00:00
abstract::The kinetics of morphine were studied during balanced anaesthesia in 10 patients undergoing lower abdominal or body surface surgery, and compared with those obtained in nine awake patients receiving morphine i.v. for the relief of chronic non-cancer pain. All patients received morphine sulfphate pentahydrate 10 mg i.v...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/62.1.22
更新日期:1989-01-01 00:00:00
abstract::Infusion thrombophlebitis is a common complication of i.v. infusions. Many factors appear to be involved in its aetiology, of which the duration of infusion, the drugs infused and the solution(s) infused are the most important. Effective prophylaxis should be based on an understanding of the possible pathophysiology. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/57.2.220
更新日期:1985-02-01 00:00:00
abstract:BACKGROUND:The memory effect of dexmedetomidine has not been prospectively evaluated in children. We evaluated the feasibility of measuring memory and sedation responses in children during dexmedetomidine sedation for non-painful radiological imaging studies. Secondarily, we quantified changes in memory in relation to ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aew421
更新日期:2017-02-01 00:00:00
abstract::Acute perioperative changes in arterial pressure occur frequently, particularly in patients with cardiovascular disease or those receiving vasoactive medications, or in relation to certain cardiovascular surgical procedures. Both hypo- and hypertension are common in patients undergoing carotid surgery because of uniqu...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aep012
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:Circadian variation may affect many biological and pharmacological phenomena. METHODS:To assess circadian variations in labour pain perception, 222 consecutive nulliparous women with uncomplicated pregnancy, spontaneous labour, cervical dilatation (3-5 cm), ruptured membranes and normal fetal heart rate tra...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeh223
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Anaesthesia and surgery are associated with impairment of the immune system expressed as an excessive proinflammatory immune response and suppression of cell-mediated immunity that may affect the course of the postoperative period. Addition of anaesthetic agents capable of attenuating the alterations in peri...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aem218
更新日期:2007-10-01 00:00:00
abstract::NHS Blood and Transplant (NHSBT) was established in 2005 as a Special Health Authority when the National Blood Authority and UK Transplant merged. This helped to bring tissue banking and organ transplantation services under one umbrella organization. This merger means that ~!95% of all deceased donors (whether tissue,...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aer398
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Postoperative delirium and cognitive decline are common in elderly surgical patients after non-cardiac surgery. Despite this prevalence and clinical importance, no specific aetiological factor has been identified for postoperative delirium and cognitive decline. In experimental setting in a rat model, nitrou...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/ael106
更新日期:2006-06-01 00:00:00
abstract::During resection of a Wilms' tumour in a 10-year-old girl, sudden bradycardia, hypotension and cyanosis developed, leading to cardiac arrest. It was thought that part of the tumour had caused a pulmonary embolus. After prompt resuscitation, cardiopulmonary bypass surgery was started within 20 min. At operation the lef...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/53.8.903
更新日期:1981-08-01 00:00:00
abstract::A randomized, double-blind study of 40 women was performed to compare patient controlled anaesthesia (PCA) morphine requirements after spinal anaesthesia for elective Caesarean section. The women received 0.2 mg of either morphine or diamorphine mixed with 0.5% bupivacaine in 8% dextrose. There were no significant dif...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/81.2.135
更新日期:1998-08-01 00:00:00
abstract:BACKGROUND:Lidocaine is frequently used as an agent to treat ventricular arrhythmias associated with acute myocardial ischaemia. Lidocaine is a potent blocker not only of sodium channels, but also of ATP-sensitive potassium channels. The opening of these channels is a key mechanism of ischaemic preconditioning. We inve...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeh262
更新日期:2004-11-01 00:00:00
abstract::Animal studies suggest that alpha 2 agonists inhibit the chemoreceptor response to hypoxia. We have examined the effect of oral clonidine on the ventilatory response to sustained, isocapnic hypoxia (SpO2 79.7% (SD 1.1%) for 20 min) in eight male subjects. The hypoxic ventilatory response was measured before and after ...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/76.2.214
更新日期:1996-02-01 00:00:00
abstract::A 4-year-old girl developed severe hepatitis following the fourth administration of halothane in a period of 5 months. She was shown to have a circulating antibody which acted specifically against rabbit hepatocyte previously sensitized to halothane. The patient made a full recovery from the hepatitis, but 5 months la...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/54.3.349
更新日期:1982-03-01 00:00:00
abstract::A disposable patient-controlled analgesia (PCA) device was evaluated in 20 children after major abdominal, urological and orthopaedic surgery. All patients were given a high dependency level of nursing care in general wards. Efficacy (as assessed by hourly pain scores) was comparable to that achieved in a matched cont...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/68.4.411
更新日期:1992-04-01 00:00:00
abstract::We describe an obstetric patient who presented for removal of a retained placenta. After insertion of the spinal anaesthetic, she developed a severe headache, and a subarachnoid haemorrhage was diagnosed. We discuss the differential diagnosis of the headache, the occurrence of intracranial haemorrhages after dural pun...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/86.3.442
更新日期:2001-03-01 00:00:00
abstract::We have evaluated the effect of delivering nitric oxide using a continuous flow system (CFS) or two commercially available proportional gas injection systems (PGIS), Nodomo (Dräger, Lübeck, Germany) and Pulmonox-Mini (Messer Griesheim Austria, Gumpoldskirchen, Austria) on measured and simulated concentrations of nitri...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/81.4.544
更新日期:1998-10-01 00:00:00
abstract::It is known that propofol can have effects on atrioventricular node conduction. We report a case where administration of propofol was associated with termination of supraventricular tachycardia. Although a similar phenomenon has been reported in children, this is the first such case in an adult. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:
更新日期:2002-06-01 00:00:00
abstract:BACKGROUND:Anaesthetics blunt neuronal responses to noxious stimulation, including effects on electroencephalographic (EEG) responses. It is unclear how anaesthetics differ in their ability to modulate noxious stimulation-evoked EEG activation. We investigated the actions of propofol and halothane on EEG responses to n...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aei208
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:Myocardial injury after noncardiac surgery is common, although the exact pathophysiology is unknown. It is plausible that hypotension after surgery is relevant for the development of myocardial injury. The authors evaluated whether low mean arterial pressures (MAPs) after surgery are related to an increased ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2017.11.002
更新日期:2018-01-01 00:00:00
abstract::Local reactions after i.v. injection of diazepam, flunitrazepam and isotonic saline were studied in patients who received extradural analgesia or general anaesthesia. The frequency of thrombophlebitis on the 1st, 3rd and 5th days after the injection of diazepam was 2.1%, 17.0% and 14.9% respectively, after flunitrazep...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/52.8.817
更新日期:1980-08-01 00:00:00
abstract::A 39-year-old male suffered a closed chest deceleration injury. He presented with clinical and radiological signs consistent with trauma to the thoracic aorta, but also developed sinus bradycardia which was relieved by drainage of a haemothorax. The possible mechanisms of the changes in heart rate are discussed and di...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/72.3.358
更新日期:1994-03-01 00:00:00
abstract::We have studied the complications associated with three techniques used to maintain extradural analgesia in labour: midwife top-up doses of 0.25% bupivacaine 10 ml, continuous infusion of 0.125% bupivacaine 10 ml h-1 and patient-controlled extradural analgesia (PCEA) with self-administered 3-ml bolus doses of 0.25% bu...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/73.5.619
更新日期:1994-11-01 00:00:00
abstract::We have examined dimethylthiourea, a potent scavenger of free radicals, for its anaesthetic properties in mice and rats. In mice, dimethylthiourea abolished the righting reflex at intraperitoneal doses greater than 1.5 mg g-1 bodyweight; in rats, it decreased the MAC value for isoflurane in a dose-dependent fashion. D...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/70.4.456
更新日期:1993-04-01 00:00:00
abstract::The use of di-isopropyl phenol (Diprivan) for induction of anaesthesia was assessed in doses ranging from 1 to 3 mg kg-1. With less than 1.75mg kg-1 not all patients were anaesthetized; 2.0 mg kg-1 appeared to be a satisfactory induction dose. Involuntary muscle movement, cough and hiccup at induction were rare with a...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/53.11.1197
更新日期:1981-11-01 00:00:00
abstract::An analysis of neuromuscular transmission has been made in phrenic nerve/diaphragm preparations from male rats aged 30 days or 110 days. The amplitude of miniature end-plate potentials was found to decrease with age, being 0.969 +/- SEM 0.058 mV at 30 days and 0.510 +/- SEM 0.031 mV at 110 days. Over the same period, ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/49.3.217
更新日期:1977-03-01 00:00:00