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1.
Case Rep Anesthesiol ; 2022: 3312306, 2022.
Article in English | MEDLINE | ID: mdl-35310519

ABSTRACT

During the recent COVID-19 pandemic, the rapidly progressive shortage of intravenous sedative drugs led numerous intensive care units to look for potential alternatives in patients requiring mechanical ventilation for severe acute respiratory distress syndrome (ARDS). Inhalational sedation using the AnaConDa® device for sevoflurane administration is a possible option. In a 54-year-old COVID-19 patient with severe ARDS requiring extracorporeal membranous oxygenation (ECMO), sevoflurane on AnaConDa® device was administered for 8 days but was complicated by the development of nephrogenic diabetes insipidus (NDI). Other causes of NDI or central diabetes insipidus were reasonably excluded, as in other previously published cases of NDI in ICU patients receiving prolonged sevoflurane-based sedation. In addition, the postmortem examination suggested a lower expression of aquaporin-2 in renal tubules. This observation should prompt further investigations to elucidate the role of aquaporin-2 in sevoflurane-related NDI. Inhaled isoflurane sedation is a possible alternative.

2.
J Clin Med ; 9(2)2020 Feb 04.
Article in English | MEDLINE | ID: mdl-32033153

ABSTRACT

P2Y12 inhibitor discontinuation is essential before most surgical interventions to limit bleeding complications. Based on pharmacokinetic data, fixed discontinuation durations have been recommended. However, as platelet function recovery is highly variable among patients, a more individualized approach based on platelet function testing (PFT) has been proposed. The aim of this retrospective single-centre study was to determine whether PFT using whole blood adenosine diphosphate-multiple electrode aggregometry (ADP-MEA) was associated with a safe reduction of preoperative waiting time. Preoperative ADP-MEA was performed for 29 patients on P2Y12 inhibitors. Among those, 17 patients underwent a coronary artery bypass graft. Twenty one were operated with an ADP-MEA ≥ 19 U (quantification of the area under the aggregation curve), and the waiting time was shorter by 1.6 days (median 1.8 days, IQR 0.5-2.9), by comparison with the current recommendations (five days for clopidogrel and ticagrelor, seven days for prasugrel). Platelet function recovery was indeed highly variable among individuals. With the 19 U threshold, high residual platelet inhibition was associated with perioperative platelet transfusion. These results suggest that preoperative PFT with ADP-MEA could help reduce waiting time before urgent surgery for patients on P2Y12 inhibitors.

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