SPINAL ANESTHESIA IN DAY SURGERY - EARLY EXPERIENCES.

Day surgery is a term that refers to performing an operation under anesthesia without needing to stay in the hospital for more than 24 hours. Day surgery has many advantages over surgery that involves a multiple-day hospital stay. Anesthesia for day surgery must have a rapid onset of action, a rapid cessation of action, and be free of, or have minimal side effects. For many years, general anesthesia was believed to be the anesthesia of choice for day surgery due to the delayed onset of local anesthetic after spinal anesthesia, a much longer duration of motor function recovery after surgery with spinal anesthesia compared to general anesthesia, and a more frequent incidence of side effects with spinal anesthesia, such as urinary retention or post-puncture headache. However, with the discovery of new, shorter-acting local anesthetics, and the use of smaller-diameter spinal needles, spinal anesthesia is becoming an equivalent anesthetic option for day surgery, if not a better one. Our early expiriences with spinal anesthesia in day surgery are excellent.

Influence of tranexamic acid on postoperative autologous blood retransfusion in primary total hip and knee arthroplasty: a randomized controlled trial.

BACKGROUND: Postoperatively shed blood salvage is commonly used to reduce allogenic blood transfusion in patients undergoing total hip (THA) and knee arthroplasty (TKA). Autologous blood retransfusion is not devoid of risk. We hypothesized that adding tranexamic acid (TXA) to a restrictive blood transfusion protocol would reduce the need for postoperative autologous blood retransfusion in primary knee and hip arthroplasty. STUDY DESIGN AND METHODS: Ninety-eight adult patients undergoing primary THA or TKA were randomly assigned to receive an intraoperative intravenous loading dose of 1.0 g of TXA followed by another 1.0-g dose 3 hours later (TXA group) or a matching volume 0.9% saline placebo (control group). A postoperatively shed autologous blood recovery system was used in all patients and the minimum reinfusion volume set at 250 mL. Red blood cells were transfused if hemoglobin level was less than 8 or if 8 to 10 g/dL with symptoms of anemia. RESULTS: The proportion of patients receiving autologous blood reinfusion was significantly lower in the TXA group (5/49) compared to placebo (42/49) with an absolute difference of -75.5% (adjusted relative risk, 0.005), and none of the patients in the TXA group received more than 400 mL retransfused. Median total external blood loss during the first 24 hours was lower in the TXA group, 320 mL (range, 80-930 mL), compared to 970 mL (range, 100-2600 mL) in the placebo group (p < 0.001). There were no significant differences in homologous blood transfusions and hematologic variables between groups. Treatment differences were consistent by size and significance when the analysis was repeated separately in patients undergoing TKA or THA. CONCLUSION: Addition of TXA to a restrictive transfusion protocol makes the use of a postoperative blood salvage system in patients undergoing primary hip and knee arthroplasty unnecessary.

Measuring cardiac output during dobutamine infusion after off-pump coronary artery bypass: comparison of transesophageal echo-Doppler and thermodilution.

AIM: To compare transesophageal echo-Doppler with thermodilution method for measuring cardiac output during dobutamine infusion after off-pump coronary artery bypass. METHOD: Using transesophageal echo-Doppler and thermodilution methods, we measured cardiac output in 30 patients after off-pump coronary artery bypass, immediately before and 5, 15, and 30 min after the introduction of continuous dobutamine infusion (3 microg/kg/min). Paired t-test and Bland-Altman analysis were used to compare the results obtained by two methods in this prospective study. RESULTS: Significant increase in cardiac output during dobutamine infusion was detected by both thermodilution (from 3.9 +/- 1.0 to 4.6 +/- 1.1 L/min; p < 0.001) and transesophageal echo-Doppler (from 3.8 +/- 1.2 to 4.8 +/- 1.4 L/min; p < 0.001). Initial measurement results of thermodilution and transesophageal echo-Doppler techniques showed clinically acceptable agreement, with a mean difference of only + 0.09 L/min (95% confidence interval (CI), 0.42 to + 0.61). Subsequently repeated measurements after 5, 15, and 30 min showed almost the same agreement between the methods. The highest mean difference between the initial and repeated measurements was found at 5 min after the introduction of dobutamine infusion (-0.29 L/min, 95% CI, -1.06 to + 0.48). CONCLUSION: Transesophageal echo-Doppler and thermodilution can be interchangeable as methods for measuring cardiac output after off-pump coronary artery bypass.