Rotation thromboelastometry velocity curve predicts blood loss during liver transplantation.

BACKGROUND: Patients undergoing liver transplantation (LT) have a high risk of bleeding. The goal of this study was to assess whether the first derivative of the velocity waveform (V-curve) generated by whole blood rotation thromboelastometry (ROTEM®) can predict blood loss during LT. METHODS: Preoperative V-curve parameters were retrospectively evaluated in 198 patients. Patients were divided into quartiles based on blood loss: low (LBL) in the first quartile and high (HBL) in the higher quartiles. A subgroup analysis was performed with patients stratified according to cirrhosis aetiology. A logistic regression model and receiver operator characteristics (ROC) curve were used to test the capacity of the V-curve, to discriminate between LBL and HBL. RESULTS: In the HBL group, the V-curve showed a lower maximum velocity of clot generation (MaxVel), a lower area under maximum velocity curve (AUC), and a higher time-to-maximum velocity (t-MaxVel) than in the LBL group. t-MaxVel was the only parameter showing a capacity to discriminate between the two groups, with a ROC area of 0.69 (95% CI; 0.62-0.74). The ROC area was 0.78 (95% CI; 0.75-0.83) for the 148 patients with cirrhosis, 0.73 (0.60-0.82) for patients with viral hepatitis and 0.83 (0.78-0.96) for patients with alcoholic hepatitis, the group that showed the best discriminative capacity. Moderate but significant correlations were found between all parameters of V-curve and BL. CONCLUSIONS: Pre-transplant V-curve obtained from ROTEM is a promising tool for predicting BL risk during LT, particularly in patients with cirrhosis.

[Incidence of cough after desflurane and sevoflurane administration through a laryngeal mask: a controlled clinical trial]. / Comparación de la incidencia de tos entre desflurano y sevoflurano cuando se utiliza la máscara laríngea. Ensayo clínico controlado.

OBJECTIVE: To determine the incidence of cough with the administration of desflurane and sevoflurane through a laryngeal mask. METHODS: A double-blind controlled clinical trial in 90 patients who received general anesthesia for ear, nose and throat surgery outpatient. The experimental group (n = 45) inhaled desflurane and the control group (n = 45) inhaled sevoflurane. Rugloop simulation software was used to assure that each patient was under the effect of the induction agent (propofol). The Gasman program was used to ascertain that a minimum alveolar concentration of 1 had been achieved before the hypnotic effect of propofol was lost. Cough was evaluated on the Shahbaz scale during the 10 minutes following induction and at the end of the procedure. RESULTS: Cough in the first 10 minutes was recorded in 53.6% of patients in the desflurane group and in 2.4% in the sevoflurane group (P < .05). Between-group differences were also evident at the end of surgery (desflurane group, 24%; sevoflurane group, 9.7%; P< .05). CONCLUSION: The patients who inhaled desflurane through a laryngeal mask had a higher incidence of cough than those who inhaled sevoflurane. The mechanism by which cough is being triggered by desflurane should be studied to determine whether the effect is chemical or mechanical and whether it is acting in the larynx or in the distal portion of the lung.

Comparación de la incidencia de tos entre desflurano y sevoflurano cuando se utiliza la máscara laríngea. Ensayo clínico controlado / Incidence of cough after desflurane and sevoflurane administration through a laryngeal mask: a controlled clinical trial

OBJETIVO: Determinar la incidencia de tos con desfluranoy sevoflurano cuando se administra anestesia utilizandomáscara laríngea.MÉTODOS: Se realizó un ensayo clínico controlado condoble enmascaramiento, en 90 pacientes que recibieronanestesia general para cirugía ambulatoria de otorrinolaringología.Dos grupos definidos para el estudio, grupoexperimental n = 45 y grupo control n = 45, recibieronanestesia inhalatoria. Se consideró grupo experimentalel que recibió desflurano y grupo control el que recibiósevoflurano. Se utilizó el simulador Rugloop para asegurarque el paciente estaba bajo efecto del inductor, propofol,y el Gasman para alcanzar 1 CAM antes de finalizarel efecto hipnótico del mismo. La ocurrencia de tosfue evaluada con la escala utilizada previamente porShahbaz R., durante los diez minutos siguientes a lainducción y al final del procedimiento.RESULTADOS: La incidencia de tos en el grupo de desfluranoen los primeros diez minutos de la observaciónfue 53,6%, mientras que en el grupo de sevoflurano fue2,4% (p < 0,05). Esta diferencia se mantuvo en ambosgrupos al final del procedimiento quirúrgico siendo de24% en el grupo desflurano y de 9,7% en el de sevoflurano(p < 0,05).CONCLUSIÓN: Los pacientes que reciben anestesiainhalada con desflurano a través de mascara laríngea,presentan mayor incidencia de tos que aquellos que recibensevoflurano por la misma vía. Son necesarios estudiosmecanísticos para aclarar si la tos producida por eldesflurano es consecuencia de un estímulo químico omecánico a nivel de la laringe o de la vía aérea distalpulmonar(AU)

OBJECTIVE: To determine the incidence of cough withthe administration of desflurane and sevofluranethrough a laryngeal mask.METHODS: A double-blind controlled clinical trial in90 patients who received general anesthesia for ear, noseand throat surgery outpatient. The experimental group(n = 45) inhaled desflurane and the control group(n = 45) inhaled sevoflurane. Rugloop simulationsoftware was used to assure that each patient was underthe effect of the induction agent (propofol). The Gasmanprogram was used to ascertain that a minimum alveolarconcentration of 1 had been achieved before thehypnotic effect of propofol was lost. Cough wasevaluated on the Shahbaz scale during the 10 minutesfollowing induction and at the end of the procedure.RESULTS: Cough in the first 10 minutes was recordedin 53.6% of patients in the desflurane group and in 2.4%in the sevoflurane group (P < .05). Between-groupdifferences were also evident at the end of surgery(desflurane group, 24%; sevoflurane group, 9.7%;P < .05).CONCLUSION: The patients who inhaled desfluranethrough a laryngeal mask had a higher incidence ofcough than those who inhaled sevoflurane. Themechanism by which cough is being triggered bydesflurane should be studied to determine whether theeffect is chemical or mechanical and whether it is actingin the larynx or in the distal portion of the lung(AU)