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PURPOSE To highlight a case in which multiple errors occurred during programming and administration of analgesia via a patient-controlled analgesia (PCA) pump, and to formulate recommendations on how to avoid such errors in the future. CLINICAL FEATURES Following lumbar surgery, a 43-yr-old woman was switched from epidural analgesia to a PCA pump. This(More)
INTRODUCTION Coagulopathy leading to excessive blood loss is a serious complication of cardiac surgery. In this prospective cohort study, we measured patients' coagulation status before and after cardiopulmonary bypass (CPB) and examined their relationships with postoperative blood loss. METHODS Patients undergoing complex cardiac surgery with CPB who did(More)
PURPOSE Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Anemia and red blood cell (RBC) transfusion have individually been identified as potentially modifiable risk factors, but their interrelationship with AKI has not been clearly defined. The purpose of this study was to explore the interrelationship of preoperative(More)
BACKGROUND Remote ischemic preconditioning is a simple therapy that may reduce cardiac and kidney injury. We undertook a randomized controlled trial to evaluate the effect of this therapy on markers of heart and kidney injury after cardiac surgery. METHODS Patients at high risk of death within 30 days after cardiac surgery were randomly assigned to(More)
BACKGROUND Cerebral oxygen desaturation during cardiac surgery has been associated with adverse perioperative outcomes. Before a large multicenter randomized controlled trial (RCT) on the impact of preventing desaturations on perioperative outcomes, the authors undertook a randomized prospective, parallel-arm, multicenter feasibility RCT to determine(More)
1153 December 2012 I N this issue of Anesthesiology, Karkouti et al.1 use population-based administrative healthcare databases to estimate the impact of erythrocyte transfusion on postoperative outcomes after elective hip or knee replacement surgeries. They demonstrate that there is a major discrepancy in the estimation of the impact of erythrocyte(More)
PURPOSE Recombinant activated factor VII (rFVIIa) is a pro-hemostatic drug that is approved for treatment of bleeding in hemophilia patients, but it is frequently used off-label in non-hemophiliacs. The purpose of this study was to determine if the off-label use of rFVIIa is expanding and whether this poses a net harm to patients. METHODS For this(More)
BACKGROUND Tranexamic acid (TXA) is commonly administered during on-pump cardiac surgery to minimize bleeding. However, an optimal dosing regimen has not been described, and recent studies suggest that higher doses may be associated with seizure. Little is known about current practice among cardiac anesthetists. METHODS We contacted all academic(More)
Background The effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear. Methods In this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE)(More)