Assuntos
Procedimentos Cirúrgicos Cardíacos , Ressuscitação , Albuminas , Hidratação , Humanos , Albumina Sérica HumanaAssuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Derivados de Hidroxietil Amido/efeitos adversos , Substitutos do Plasma/efeitos adversos , Formulários de Hospitais como Assunto , Humanos , Derivados de Hidroxietil Amido/administração & dosagem , Derivados de Hidroxietil Amido/química , Substitutos do Plasma/administração & dosagem , Substitutos do Plasma/químicaRESUMO
OBJECTIVE: The effects of hydroxyethyl starch on bleeding after cardiopulmonary bypass were determined. METHODS: A meta-analysis was performed of postoperative blood loss in randomized clinical trials of hydroxyethyl starch versus albumin for fluid management in adult cardiopulmonary bypass surgery. Impacts of hydroxyethyl starch molecular weight and molar substitution were assessed. Randomized trials directly comparing different hydroxyethyl starch solutions were also included. RESULTS: Eighteen trials with 970 total patients were included. Compared with albumin, hydroxyethyl starch increased postoperative blood loss by 33.3% of a pooled SD (95% confidence interval, 18.2%-48.3%; P < .001). Risk of reoperation for bleeding was more than doubled by hydroxyethyl starch (relative risk, 2.24; 95% confidence interval, 1.14-4.40; P = .020). Hydroxyethyl starch increased transfusion of red blood cells by 28.4% of a pooled SD (95% confidence interval, 12.2%-44.6%; P < .001), of fresh-frozen plasma by 30.6% (95% confidence interval, 8.0%-53.1%; P = .008), and of platelets by 29.8% (95% confidence interval, 3.4%-56.2%; P = .027). None of these effects differed significantly between hydroxyethyl starch 450/0.7 and 200/0.5. Insufficient data were available for hydroxyethyl starch 130/0.4 versus albumin; however, no significant differences were detected in head-to-head comparisons of hydroxyethyl starch 130/0.4 with 200/0.5. Albumin improved hemodynamics. There were no differences in fluid balance, ventilator time, intensive care unit stay, or mortality. CONCLUSIONS: Hydroxyethyl starch increased blood loss, reoperation for bleeding, and blood product transfusion after cardiopulmonary bypass. There was no evidence that these risks could be mitigated by lower molecular weight and substitution.
Assuntos
Ponte de Artéria Coronária , Derivados de Hidroxietil Amido/efeitos adversos , Substitutos do Plasma/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Albuminas/efeitos adversos , Transfusão de Sangue , Hemodinâmica , Humanos , Reoperação , Fatores de RiscoAssuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Hemodinâmica/efeitos dos fármacos , Derivados de Hidroxietil Amido/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Derivados de Hidroxietil Amido/farmacologia , Incidência , Cuidados Intraoperatórios/métodos , Masculino , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/fisiopatologia , Valores de Referência , Medição de Risco , Taxa de SobrevidaRESUMO
Waters and Stafford (Reports, 23 February 2007, p. 1122) provided useful information about the age of some Clovis sites but have not definitively established the temporal span of this cultural complex in the Americas. Only a continuing program of radiometric dating and careful stratigraphic correlations can address the lingering ambiguity about the emergence and spread of Clovis culture.
Assuntos
Arqueologia , Cultura , Emigração e Imigração , História Antiga , Humanos , América do Norte , América do Sul , TempoAssuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Derivados de Hidroxietil Amido/efeitos adversos , Substitutos do Plasma/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Insuficiência Renal/etiologia , Coagulação Sanguínea/efeitos dos fármacos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar , Gelatina/efeitos adversos , Humanos , Hemorragia Pós-Operatória/prevenção & controle , Insuficiência Renal/prevenção & controleRESUMO
The presence of central sensitization and cutaneous allodynia has not been readily studied in other primary headache syndromes outside of migraine. If central sensitization does occur, is the temporal profile any different in the short-lasting more aggressive syndromes such as SUNCT than in migraine? A patient with SUNCT was examined during and in between attacks looking for the presence and duration of cutaneous allodynia.
Assuntos
Transtornos da Cefaleia/complicações , Hiperalgesia/fisiopatologia , Pele/fisiopatologia , Adulto , Olho/fisiopatologia , Humanos , Masculino , Dor/etiologia , Dor/fisiopatologia , Síndrome , LágrimasRESUMO
In this study, we sought to determine the long-term effect of the additional year of anesthesia residency (postgraduate year [PGY]-4) instituted in 1989 by the American Board of Anesthesiology on the number of individuals who pursued 12-mo subspecialty anesthesia training. We tested the hypothesis that extending education by a year would decrease the number of anesthesia subspecialty trainees. Surveys were collected from approved anesthesia residency training programs in the United States from 1989 to 2001. The questionnaires determined the number of individuals pursuing subspecialty training during PGY-4 and PGY-5. The subspecialties included cardiac anesthesia, pediatric anesthesia, pain management, obstetrical anesthesia, neuroanesthesia, outpatient anesthesia, intensive care medicine, and research. The number of anesthesiology residents (PGY-5) pursuing 12-mo subspecialty training increased over this period. The specific subspecialty distribution of fellows changed, with the largest increase in number and percentage occurring in pain management. The largest declines occurred in critical care medicine and research. Our data do not indicate a decrease in the number of anesthesiology subspecialists. Factors other than the duration of training appear responsible for the selection of subspecialty education.
