Overuse of preoperative laboratory coagulation testing and ABO blood typing: a French national study.

Background: Following publication of guidelines on routine preoperative tests, the French Society of Anaesthesiology and Intensive Care (SFAR), in association with French national public health insurance, conducted a survey to evaluate adherence to guidelines and the economic consequences. Methods: Using the French Hospital Discharge Database and National Health Insurance Information system, tests performed during the 30 days before surgery were analysed for two situations: (1) standard laboratory coagulation tests and ABO blood typing in children able to walk and scheduled for tonsillectomy/adenoidectomy; and (2) ABO blood typing in adults before laparoscopic cholecystectomy, thyroidectomy, lumbar discectomy or breast surgery. Guidelines do not recommend any preoperative tests in these settings. Results: Between 2013 and 2015, a coagulation test was performed in 49% of the 241 017 children who underwent tonsillectomy and 39% of the 133 790 children who underwent adenoidectomy. A similar pattern was observed for ABO blood typing although re-operation rates for bleeding on the first postoperative day were very low (0.12-0.31% for tonsillectomy and 0.01-0.02% for adenoidectomy). Between 2012 and 2015, ABO blood typing was performed in 32-45% of the 1 114 082 patients who underwent one of the four selected procedures. The transfusion rate was very low (0.02-0.31%). The mean cost for the four procedures over the 4 yr period was €5 310 000 (sd €325 000). Conclusions: Standard laboratory coagulation tests and ABO blood typing are still routinely prescribed before surgery and anaesthesia despite current guidelines. This over-prescription represents a high and unnecessary cost, and should therefore be addressed.

Decreased sensitivity of neonatal rabbit sarcoplasmic reticulum to anthracycline cardiotoxicity.

Anthracyclines are useful chemotherapeutic agents whose utility is limited by the development of irreversible cardiotoxicity. When tested, the pediatric population demonstrates an increased sensitivity to the cardiotoxicity of this class of agents, although the reasons for this increased sensitivity are unclear. The sarcoplasmic reticulum (SR) is a target for anthracycline cardiotoxicity in adults, but the effects of anthracycline on the SR in developing myocardium have not been examined. It may be possible to gain insight into the mechanisms of cardiotoxicity through a comparative approach. We compared the acute effects of doxorubicin, daunorubicin, and caffeine on contractile function in adult and neonatal rabbit myocardium. Frequency-dependent contractility, 90% relaxation times, and postrest potentiated contractions (a uniquely SR-dependent phenomenon) in adult myocardium were inhibited in a concentration- dependent manner. Neonatal myocardium, however, was resistant to the effects of these agents. The degree of contractile dysfunction was consistent with the difference in SR maturation between adult and developing myocardium. Anthracyclines exhibited effects similar to those of caffeine, an agent known to render the SR nonfunctional by the depletion of the releasable SR calcium pool. These results suggest that anthracyclines induce acute cardiac lesions through effects on the SR in adults, whereas cardiotoxic effects in the developing myocardium may proceed by a different mechanism.