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1. Perioperative Hypothermia (33°C) Does Not Increase the Occurrence of Cardiovascular Events in Patients Undergoing Cerebral Aneurysm Surgery

Author

D. Chartrand, Michael Beven, C. Salem, W. Burnett, S. Jackson, G. Downey, Michael T. Lawton, S. Lownie, R. Tack, E. Dy, Tord D. Alden, David R. McIlroy, Lis Evered, K. Lukitto, L. Kirby, Thomas A. Moore, R. Popovic, N. Robertson, Patrick W. Hitchon, A. Ashtari, R. Elbe, N. F. Kassell, D. Dulli, A. Wyss, G. Ghazali, S. Rice, Gavin W. Britz, P. Bennett, Karen B. Domino, A. Shahen, D. Dehring, Robert Greif, Argye E. Hillis, L. Meng, D. Fishback, Fred Gentili, Mark Buckland, B. Schaefer, H. Madder, C. Weasler, Anish Bhardwaj, E. Thomson, Ramez W. Kirollos, Basil F. Matta, Kevin H. Siu, H. Machlin, W. Pfisterer, A. Freymuth, N. Badner, R. Wilson, R. Grauer, Zhiyi Zuo, A. McAllister, Z. Sha, A. Rushton, D. Hill, William T. Clarke, L. Jensen, G. Heard, L. Clark, D. Chatfield, J. Haartsen, Jing Wang, S. Nobles, Renee Testa, P. D'Urso, Hossam El-Beheiry, David J. Stone, James C. Torner, Michael J. Souter, A. Meyer, Marek A. Mirski, Marlan R. Hansen, W. Jenkins, L. Pobereskin, J. Walkes, M. Quigley, R. Struthers, James H McMahon, Howard A. Riina, Behnam Badie, P. Heppner, Simon Jones, R. Silbergleit, Thomas N. Pajewski, T. Broderick, Katherine Harris, P. Smythe, N. Duggal, J. Quaedackers, J. Mason, P. E. Bickler, P. McNeill, V. Roelfsema, I. Gibmeier, C. Chambers, H. Gramke, D. Campbell, T. Novick, O. Moise, J. Woletz, Lorri A. Lee, H. Van Aken, Adrian W. Gelb, A. Kane, B. Rapf, Martin S. Angst, S. Shaikh, D. Sirhan, C. Miller, B. Hodkinson, D. Leggett, F. Johnson, Harry J. M. Lemmens, M. Langley, Y. Young, Jeffrey V. Rosenfeld, C. Moy, W. Hamm, C. Hall, G. Henry, R. Burnstein, Lisa Hannegan, A. Buchmann, R. Schatzer, Bruce P. Hermann, John E. McGillicuddy, Bruno Giordani, John C. VanGilder, Keith H. Berge, D. Sage, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, T. Hartman, Laurel E. Moore, S. Bhatia, Richard A. Jaffe, G. Seever, D. Cowie, Jonathan G. Zaroff, C. Duffy, Deborah A. Rusy, Elana Farace, H R Winn, Paul H. Ting, R. Spinka, J. Marler, Patricia H. Petrozza, S. Harding, Lauren C. Berkow, E. Cunningham, D. Bisnaire, D. Wilhite, P. Blanton, S. Laurent, O. Odukoya, Issam A. Awad, P. Chery, C. Lind, B. Bauer, D. Lindholm, K. Kieburtz, J. Ormrod, Michael P. Murphy, Timothy G. Short, Y. Painchaud, R. Peters, Peter C. Whitfield, D. Bain, B. Hindman, A. Shelton, A. Morris, D. Milovan, L. Salvia, William L. Young, S. Wallace, W. Lilley, H. Yi, R. Chelliah, David W. Newell, R. Deam, John Laidlaw, P. Mak, J. Woelfer, K. Graves, Peter M. C. Wright, D. Van Alstine, M. Hemstreet, Phillip A. Scott, Steven D. Chang, S. Poustie, M. Clausen, I. Herrick, Daniel H. Kim, Vladimir Zelman, John L.D. Atkinson, Marcel E. Durieux, Alessandro Olivi, G. Smith, James R. Munis, F. Vasarhelyi, S. Olson, C. Greiner, C. Hoenemann, G. Kleinpeter, J. Kish, Daniel K. Resnick, J. Lang, Dhanesh K. Gupta, E. Knosp, N. Monteiro de Oliveira, D. Moskopp, Carin A. Hagberg, J. Howell, Klaus Hahnenkamp, Gregory M. Davis, T. Phan, Paul S. Myles, C. Beven, F. Salevsky, Maria Matuszczak, E. Mee, David L. Bogdonoff, P. Berklayd, J. Freyhoff, P. Tanzi, A. Law, Barbara A. Dodson, Z. Thayer, R. Govindaraj, Alex Konstantatos, Ralph F. Frankowski, Pirjo H. Manninen, David G. Piepgras, K. Willmann, E. Babayan, Donald S. Prough, Leslie C. Jameson, John A. Wilson, Mary Pat McAndrews, M. Abou-Madi, Steven S. Glazier, Vincent C. Traynelis, Derek A. Taggard, Fredric B. Meyer, C. Bradfield, Hoang P. Nguyen, Mary L. Marcellus, J. Ogden, M. Maleki, M. Lotto, Michael A. Olympio, C. Merhaut, D. Nye, K. Webb, Richard Leblanc, Nichol McBee, William L. Lanier, A. Molnar, Peter J. Lennarson, S. Wadanamby, H. Hulbert, Christopher R. Turner, H. Fraley, Kevin K. Tremper, Sesto Cairo, J. Shafer, J. Krugh, D. Blair, L. Coghlan, P. Schmid, K. O'Brien, K. Littlewood, T. Anderson, R. Eliazo, S. Wirtz, Carol B. Applebury, Jennifer O. Hunt, S. Hickenbottom, Hendrik Freise, Gary D. Steinberg, M. Woodfield, Robert J. Dempsey, Kirk J. Hogan, M. Harrison, H. Stanko, Teresa Bell-Stephens, N. Merah, T. Blount, J. Sanders, J. Biddulph, Tsutomu Sasaki, F. Mensink, P. Balestrieri, Lisa D. Ravdin, H. Lohmann, M. Todd, James Gebel, Lawrence Litt, Christoph Schul, B. White, Bradley J. Hindman, S. Salerno, A. James, D. Manke, Mvon Lewinski, D. Luu, Michael M. Todd, A. Drnda, S. Salsbury, J. Palmisano, L. Connery, Michael Tymianski, E. Tuffiash, Cynthia A. Lien, R. Sawyer, A. Sills, D. Sinclair, J. Bramhall, Ira J. Rampil, David M. Colonna, M. Geraghty, Steven W. Anderson, V. Petty, S. Pai, J. Sheehan, S. Black, K. English, N. Scurrah, Diana G. McGregor, P. Davies, P. Doyle-Pettypiece, H. Bone, Neal J. Naff, M. Lenaerts, James Mitchell, K. Pedersen, Matthew A. Howard, M. Angliss, Daniel Tranel, Bongin Yoo, M. Irons, Emine O. Bayman, C. Skilbeck, Nicholas G. Bircher, Wendy C. Ziai, S. Micallef, Chuanyao Tong, Kathryn Chaloner, Mark T. Wallace, John Moloney, Gavin Fabinyi, P. Sutton, Edward C. Nemergut, Elizabeth Richardson, C. McCleary, M. Graf, Mrinalini Balki, P. Porter, James J. Evans, A. Prabhu, L. Kim, R. Hendrickson, A. Dashfield, V. Portman, Michel T. Torbey, J. Kruger, Donna L. Auer, J. Sorenson, Patricia H. Davis, John A. Walker, M. Mosier, H. Smith, J. Heidler, Andrew Silvers, P. Fogarty-Mack, William F. Chandler, F. Shutway, F. Rasulo, S. Alatakis, Stephen Samples, A. Wray, Henry H. Woo, John A. Ulatowski, Steven L. Giannotta, D. Chandrasekara, J. Sturm, S. Crump, Peter A. Rasmussen, Max R. Trenerry, D. Novy, Wink S. Fisher, N. Quinnine, F. Bardenhagen, M. Angle, W. Ng, G. Ferguson, A. Blackwell, Christopher M. Loftus, James H. Fitzpatrick, David S. Warner, E. Tuerkkan, W. Kutalek, Ferenc E. Gyulai, D. Daly, Helen Fletcher, J. Smith, Mazen A. Maktabi, Howard Yonas, J. Sneyd, M. Menhusen, Johnny E. Brian, K. Smith, R. Watson, T. Weber, D. Greene-Chandos, M. Wichman, Peter Szmuk, J. Birrell, Pekka Talke, J. Jane, L. Atkins, J. Smart, T. Han, B. O'Brien, R. Mattison, Bermans J. Iskandar, J. Ridgley, S. Dalrymple, L. Lindsey, D. Anderson, Julie B. Weeks, M. Felmlee-Devine, P. Deshmukh, D. Ellegala, L. Moss, A. Mathur, F. Lee, F. Sasse, H. Macgregor, R. Peterson, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, L. Carriere, Mark Wilson, R. Morgan, T. Costello, C. Thien, Arthur M. Lam, H. Bybee, C. Salmond, Robert E. Breeze, Peter Karzmark, Monica S. Vavilala, S. Yantha, Philip E. Stieg, Guy L. Clifton, Kenneth Manzel, D. Papworth, Rafael J. Tamargo, Rosemary A. Craen, Harold P. Adams, B. Radziszewska, Y. Kuo, Satwant K. Samra, B. Frankel, R. Fry, T. Cunningham, M. Mosa, M. McTaggart, F. Steinman, Alex Abou-Chebl, Michael J. Link, Rona G. Giffard, N. Lapointe, C. Meade, Robert F. Bedford, J. Cormack, Robert P. From, J. Reynolds, Paul A. Leonard, K. Quader, N. Subhas, C. Lothaller, S. Ryan, J. Winn, H. Brors, Amin B. Kassam, A. Gelb, J. Zaroff, Gregory M. Malham, A. Redmond, Gordon J. Chelune, J. Findlay, Zeyd Ebrahim, L. Forlano, Mark E. Shaffrey, C. Chase, Peter J. Kirkpatrick, Armin Schubert, L. Koller, Jana E. Jones, P. Li, and B. Chen

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, Interventional cardiology, business.industry, Vascular disease, Perioperative, Hypothermia, medicine.disease, Preoperative care, Anesthesiology and Pain Medicine, Aneurysm, Anesthesia, Anesthesiology, Medicine, medicine.symptom, business
Abstract

Background Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing the activity of sympathetic nervous system, perioperative hypothermia also has the potential to increase cardiac injury and dysfunction associated with subarachnoid hemorrhage. Methods The Intraoperative Hypothermia for Aneurysm Surgery Trial randomized patients undergoing cerebral aneurysm surgery to intraoperative hypothermia (n = 499, 33.3 degrees +/- 0.8 degrees C) or normothermia (n = 501, 36.7 degrees +/- 0.5 degrees C). Cardiovascular events (hypotension, arrhythmias, vasopressor use, myocardial infarction, and others) were prospectively followed until 3-month follow-up and were compared in hypothermic and normothermic patients. A subset of 62 patients (hypothermia, n = 33; normothermia, n = 29) also had preoperative and postoperative (within 24 h) measurement of cardiac troponin-I and echocardiography to explore the association between perioperative hypothermia and subarachnoid hemorrhage-associated myocardial injury and left ventricular function. Results There was no difference between hypothermic and normothermic patients in the occurrence of any single cardiovascular event or in composite cardiovascular events. There was no difference in mortality (6%) between groups, and there was only a single primary cardiovascular death (normothermia). There was no difference between hypothermic and normothermic patients in postoperative versus preoperative left ventricular regional wall motion or ejection fraction. Compared with preoperative values, hypothermic patients had no postoperative increase in cardiac troponin-I (median change 0.00 microg/l), whereas normothermic patients had a small postoperative increase (median change + 0.01 microg/l, P = 0.038). Conclusion In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events.

Published
2010
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2. No Association between Intraoperative Hypothermia or Supplemental Protective Drug and Neurologic Outcomes in Patients Undergoing Temporary Clipping during Cerebral Aneurysm Surgery

Author

John A. Ulatowski, Steven L. Giannotta, J. Sturm, D. Cowie, D. Novy, N. Quinnine, James H. Fitzpatrick, David S. Warner, Ferenc E. Gyulai, D. Daly, S. Rice, H. Machlin, William T. Clarke, Philip E. Bickler, H. Van Aken, M. Langley, M. von Lewinski, G. Kleinpeter, J. Freyhoff, A. Morris, L. Salvia, Peter M. C. Wright, Wolfgang K. Pfisterer, K. English, M. Lenaerts, Nicholas G. Bircher, Simon Jones, L. Jensen, Issam A. Awad, P. Chery, B. Schaefer, S. Wallace, F. Johnson, H. Smith, J. Biddulph, T. Cunningham, N. Monteirode Oliveira, R. Watson, A. McAllister, D. Moskopp, Patricia H. Petrozza, B. Hindman, A. Shelton, D. Manke, F. Steinman, D. Luu, Alex Abou-Chebl, J. Birrell, M. Irons, J. Ridgley, Gavin Fabinyi, S. Alatakis, Basil F. Matta, James J. Evans, A. Prabhu, Rona G. Giffard, H. Gramke, Hendrik Freise, K. Graves, P. Fogarty-Mack, L. Clark, Wink S. Fisher, K. Smith, Renee Testa, P. D'Urso, A. Freymuth, James C. Torner, M. Wallace, R. Struthers, Howard A. Riina, Z. Thayer, Daniel Tranel, E. Knosp, E. Dy, Tord D. Alden, Henry H. Woo, Bruce P. Hermann, John C. VanGilder, Douglas Campbell, N. Lapointe, Gavin W. Britz, J. Sheehan, C. Meade, M. Balki, C. Bradfield, Alessandro Olivi, P. Doyle-Pettypiece, Robert F. Bedford, F. Bardenhagen, M. Angle, Donald S. Prough, John E. McGillicuddy, A. Drnda, M. Abou-Madi, S. Black, David R. McIlroy, Lis Evered, S. Poustie, J. Cormack, J. Sneyd, M. Menhusen, William L. Lanier, M. Maleki, T. Phan, D. Nye, M. Graf, Michael A. Olympio, N. Robertson, Teresa Bell-Stephens, E. Tuerkkan, N. Merah, S. Olson, L. Kirby, L. Moss, Peter Heppner, Thomas A. Moore, J. Bramhall, H. Madder, Christopher R. Turner, H. Fraley, James Mitchell, K. Pedersen, M. Angliss, Robert P. From, Y. Painchaud, Gary D. Steinberg, J. Woelfer, K. Littlewood, T. Anderson, J. Palmisano, M. Clausen, Paul H. Ting, Lisa D. Ravdin, H. Lohmann, R. Burnstein, R. Popovic, T. Hartman, D. Anderson, Julie B. Weeks, H. Macgregor, Kirk J. Hogan, D. Chatfield, Daniel H. Kim, James R. Munis, J. Lang, J. Reynolds, Michael M. Todd, F. Mensink, L. Pobereskin, J. Walkes, Mary Pat McAndrews, A. Sills, Bongin Yoo, P. Balestrieri, S. Micallef, Mary L. Marcellus, J. Wang, Kathryn Chaloner, Patrick W. Hitchon, Paul A. Leonard, C. McCleary, Lawrence Litt, N. Subhas, Wendy C. Ziai, James H McMahon, V. Petty, P. Smythe, G. Heard, Michael J. Souter, R. Hendrickson, A. Dashfield, V. Portman, Edward C. Nemergut, Patricia H. Davis, W. Burnett, M. Lotto, Y. Young, S. Jackson, J. Quaedackers, S. Ryan, Helen Fletcher, A. Ashtari, N. F. Kassell, Anish Bhardwaj, E. Thomson, Ramez W. Kirollos, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, J. Winn, Bradley J. Hindman, S. Salerno, L. Kim, R. Sawyer, Peter J. Lennarson, S. Wadanamby, Zhiyi Zuo, William F. Chandler, F. Shutway, P. Bennett, C. Merhaut, D. Hill, J. Haartsen, N. Badner, T. Weber, Rafael J. Tamargo, D. Fishback, Rosemary A. Craen, Michel T. Torbey, O. Odukoya, D. Chartrand, J. Jane, Michael T. Lawton, A. Buchmann, Richard A. Jaffe, P. Berklayd, T. Blount, J. Sanders, J. Marler, L. Meng, R. Grauer, Y. Kuo, O. Moise, P. Tanzi, R. Govindaraj, Alex Konstantatos, D. Greene-Chandos, G. Downey, M. Wichman, D. Chandrasekara, Amin B. Kassam, Max R. Trenerry, R. Elbe, A. Wyss, R. Peterson, D. Sirhan, C. Miller, Marek A. Mirski, Stephen Samples, H. Brors, Michael Beven, M. Woodfield, William L. Young, D. Leggett, A. Wray, Karen B. Domino, Robert Greif, Argye E. Hillis, Gary G. Ferguson, Steven S. Glazier, J. Shafer, J. Krugh, I. Gibmeier, G. Ghazali, W. Ng, R. Tack, R. Schatzer, B. O'Brien, Bermans J. Iskandar, B. Bauer, C. Lind, C. Weasler, Michael Tymianski, E. Tuffiash, W. Hamm, C. Hall, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, Richard Leblanc, A. Shahen, Laurel E. Moore, S. Bhatia, Nichol McBee, P. Davies, James Gebel, Cynthia A. Lien, J. Ormrod, David M. Colonna, D. Dehring, A. Rushton, P. Blanton, C. Lothaller, Diana G. McGregor, S. Harding, Lauren C. Berkow, D. Van Alstine, M. Hemstreet, A. Blackwell, Christopher M. Loftus, Klaus Hahnenkamp, J. Woletz, D. Lindholm, K. Kieburtz, M. Geraghty, Steven W. Anderson, D. Dulli, M. McTaggart, Fred Gentili, Johnny E. Brian, R. Peters, C. Greiner, Marlan R. Hansen, W. Jenkins, T. Broderick, Katherine Harris, B. Radziszewska, Maria Matuszczak, David L. Bogdonoff, K. Quader, Pekka Talke, B. Hodkinson, C. Hoenemann, C. Duffy, Deborah A. Rusy, R. Silbergleit, J. Findlay, Gregory M. Davis, J. Ogden, Adrian W. Gelb, A. Kane, Satwant K. Samra, E. Babayan, S. Dalrymple, Harry J. M. Lemmens, Tsutomu Sasaki, Lisa Hannegan, R. Eliazo, B. Frankel, D. Bisnaire, F. Salevsky, Michael J. Link, Jeffrey V. Rosenfeld, D. Sage, D. Sinclair, Keith H. Berge, D. Wilhite, Steven D. Chang, J. Kish, Carin A. Hagberg, Matthew A. Howard, Elizabeth Richardson, Peter C. Whitfield, D. Bain, Barbara A. Dodson, S. Crump, David G. Piepgras, John A. Wilson, David W. Newell, R. Deam, John Laidlaw, K. Willmann, J. Heidler, Vincent C. Traynelis, K. Webb, P. Li, A. Mathur, S. Hickenbottom, S. Wirtz, L. Lindsey, H. Stanko, Mark Wilson, S. Salsbury, L. Connery, Robert J. Dempsey, Edward W. Mee, R. Morgan, Ira J. Rampil, V. Roelfsema, Christoph Schul, B. White, A. James, N. Scurrah, C. Thien, Arthur M. Lam, P. Mak, Behnam Badie, Guy L. Clifton, R. Wilson, J. Kruger, Donna L. Auer, M. Mosier, S. Nobles, David J. Stone, A. Law, Timothy G. Short, W. Lilley, H. Yi, Marcel E. Durieux, Daniel K. Resnick, Dhanesh K. Gupta, Paul S. Myles, C. Beven, Thomas N. Pajewski, J. Mason, P. McNeill, F. Lee, Bruno Giordani, Leslie C. Jameson, G. Seever, Stephen P. Lownie, Fredric B. Meyer, P. Porter, K. O'Brien, Vladimir Zelman, John L.D. Atkinson, A. Molnar, H. Hulbert, S. Pai, Neal J. Naff, S. Shaikh, M. Mosa, Pirjo H. Manninen, Derek A. Taggard, Ian A. Herrick, Mark E. Shaffrey, Carol B. Applebury, C. Chase, Neil Duggal, Mark Buckland, M. Quigley, D. Milovan, Michael J. Harrison, Peter J. Kirkpatrick, Armin Schubert, R. Mattison, Ralph F. Frankowski, R. Chelliah, Jana E. Jones, J. Howell, H. Bone, Emine O. Bayman, P. Deshmukh, C. Skilbeck, P. Sutton, B. Chen, L. Carriere, J. Sorenson, Andrew Silvers, F. Sasse, F. Rasulo, Gordon J. Chelune, Zeyd Ebrahim, L. Forlano, Chuanyao Tong, John Moloney, Michael P. Murphy, S. Yantha, W. Kutalek, Kevin K. Tremper, C. Chambers, Sesto Cairo, Robert E. Breeze, A. Meyer, Monica S. Vavilala, C. Salem, H. El-Beheiry, Gregory M. Malham, A. Redmond, L. Koller, Kenneth Manzel, D. Papworth, C. Moy, G. Henry, Elana Farace, H R Winn, E. Cunningham, B. Rapf, J. Smith, Mazen A. Maktabi, Howard Yonas, D. Ellegala, Kevin H. Siu, Lorri A. Lee, Phillip A. Scott, K. Lukitto, Jennifer O. Hunt, D. Blair, P. Schmid, M. Felmlee-Devine, Peter A. Rasmussen, Peter Szmuk, L. Atkins, J. Smart, T. Han, T. Costello, H. Bybee, C. Salmond, Peter Karzmark, Philip E. Stieg, Harold P. Adams, T. Novick, Z. Sha, Martin S. Angst, S. Laurent, G. Smith, F. Vasarhelyi, R. A. Fry, and John A. Walker

Subjects
medicine.medical_specialty, business.industry, Vascular disease, Glasgow Outcome Scale, Odds ratio, Hypothermia, medicine.disease, law.invention, Surgery, Anesthesiology and Pain Medicine, Aneurysm, Randomized controlled trial, law, Anesthesia, Anesthesiology, Medicine, medicine.symptom, business, Prospective cohort study
Abstract

Background Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. Methods A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression methods were used to test for associations between hypothermia, supplemental protective drug, and short- (24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Results Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. Conclusion In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

Published
2010
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3. Preoperative Antiplatelet Therapy Does Not Increase the Risk of Spinal Hematoma Associated with Regional Anesthesia

Author

Denise J. Wedel, Gilbert Y. Wong, Steven H. Rose, Darrell R. Schroeder, Beth A. Elliott, Terese T. Horlocker, and Diana G. McGregor

Subjects
Adult, Anesthesia, Epidural, Male, medicine.medical_specialty, Antiplatelet drug, Adolescent, medicine.medical_treatment, Anesthesia, Spinal, Spinal Puncture, Hematoma, medicine, Humans, Spinal canal, Prospective Studies, Risk factor, Aged, Aged, 80 and over, Aspirin, business.industry, Platelet Count, Middle Aged, medicine.disease, Epidural space, Surgery, Catheter, medicine.anatomical_structure, Orthopedics, Anesthesiology and Pain Medicine, Anesthesia, Female, Spinal Diseases, business, Complication, Platelet Aggregation Inhibitors, medicine.drug
Abstract

One thousand orthopedic procedures in 924 patients given spinal or epidural anesthesia were prospectively studied to determine the risk of hemorrhagic complications associated with regional anesthesia. A history of excessive bruising or bleeding was elicited in 115 (12%) patients. Preoperative antiplatelet medications were taken by 386 (39%) patients. Aspirin was the most frequently reported antiplatelet drug and was taken by 193 patients. Subcutaneous heparin was administered to 22 patients before surgery on the operative day. One patient of 774 tested had a preoperative platelet count less than 100,000/mm3. In addition, 26 of 171 preoperative prothrombin times and 10 of 115 preoperative activated partial thromboplastin times were longer than normal. Only 31 preoperative bleeding times were performed; five were prolonged. There were no documented spinal hematomas (major hemorrhagic complications). Blood was noted during needle or catheter placement (minor hemorrhagic complication) in 223 (22%) patients, including 73 patients with frank blood in the needle or catheter. Preoperative antiplatelet therapy did not increase the incidence of minor hemorrhagic complications. However, female gender, increased age, a history of excessive bruising/bleeding, surgery to the hip, continuous catheter anesthetic technique, large needle gauge, multiple needle passes, and moderate or difficult needle placement were all significant risk factors. The lack of correlation between antiplatelet medications and bloody needle or catheter placement (producing clinically insignificant collections of blood in the spinal canal or epidural space) is strong evidence that preoperative antiplatelet therapy is not a significant risk factor for the development of neurologic dysfunction from spinal hematoma in patients who undergo spinal or epidural anesthesia while receiving these medications.

Published
1995
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4. Hyperglycemia in patients undergoing cerebral aneurysm surgery: its association with long-term gross neurologic and neuropsychological function

Author

Jeffrey J. Pasternak, Qian Shi, William L. Lanier, Darrell R. Schroeder, Julie B. Weeks, Diana G. McGregor, Bradley J. Hindman, William R. Clarke, Michael M. Todd, and James C. Torner

Subjects
Blood Glucose, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Time Factors, Logistic regression, Brain Ischemia, Central nervous system disease, Aneurysm, Cognition, Postoperative Complications, Risk Factors, Monitoring, Intraoperative, medicine, Humans, In patient, Retrospective Studies, Vascular disease, business.industry, Intracranial Aneurysm, General Medicine, Length of Stay, Middle Aged, medicine.disease, Prognosis, Hypoglycemia, Surgery, Quartile, Anesthesia, Aneurysm surgery, Female, business, Vascular Surgical Procedures, Follow-Up Studies
Abstract

To evaluate whether elevated intraoperative blood glucose concentrations are associated with an increased risk of long-term neurologic dysfunction in patients at risk for ischemic brain injury.Data from 1000 patients were retrieved from the Intraoperative Hypothermia for Aneurysm Surgery Trial database. All patients were recruited between February 2000 and April 2003, and underwent surgery for aneurysm clipping within 14 days of subarachnoid hemorrhage. Gross neurologic and neuropsychological function was evaluated at 3 months after surgery using certified observers and standardized assessment instruments. Intraoperative blood glucose concentrations, measured once when the aneurysm clip was placed, were correlated with neurologic outcome using both univariable and multivariable logistic regression analyses.Blood glucose concentrations at the time of aneurysm clipping ranged from 59 to 331 mg/dL. At 3 months after surgery, those with blood glucose concentrations of 129 mg/dL or more (upper 2 quartiles) were more likely to have impaired cognition (P=.03). Those with glucose concentrations of 152 mg/dL or more (upper quartile) were more likely to experience deficits in gross neurologic function assessed by the National Institutes of Health Stroke Scale (P.05), but not other scoring scales. Length of stay in intensive care units was longer in those with glucose concentrations of 129 mg/dL or more, but there was no difference among glucose groups in the duration of overall hospital stay or the fraction of patients discharged to home.In patients at high risk for ischemic brain injury, intraoperative hyperglycemia, of a magnitude commonly encountered clinically, was associated with long-term changes in cognition and gross neurologic function.

Published
2008

5. Trace nitrous oxide levels in the postanesthesia care unit

Author

Diana G. McGregor, Richard I. Mazze, and David H. Senjem

Subjects
Postanesthesia care, biology, business.industry, Nitrous Oxide, Nitrous oxide, Air Pollutants, Occupational, biology.organism_classification, Occupational safety and health, Ambient air, Pacu, chemistry.chemical_compound, Anesthesiology and Pain Medicine, chemistry, Anesthesia, Anesthetic, Anesthesia Recovery Period, Anesthetics, Inhalation, medicine, Humans, business, Postanesthesia Nursing, Hospital Units, medicine.drug
Abstract

UNLABELLED The effect of trace levels of waste anesthetic gases on the health of postanesthesia care unit (PACU) nurses who work in an unscavenged environment has been questioned, although it seems likely that levels of trace gases in the PACU would be much lower than those in the operating room. In this study, we documented nitrous oxide levels in the ambient air of two large PACUs. Nitrous oxide levels were measured using a time-weighted average monitor worn by 33 PACU workers at two different hospitals for the duration of their shifts. On the same day, patient data were collected at the time of admission to the PACU. Data included age and weight of the patient, type of surgery, anesthetic technique, and end-tidal level of nitrous oxide immediately before the patient left the operating room. The mean time-weighted average nitrous oxide level in PACU A was 2.0 ppm (range 0-6.4); in PACU B, it was undetectable, i.e., < 2.0 ppm. Levels of nitrous oxide to which PACU patient care personnel are exposed are well below the National Institute of Occupational Safety and Health and Occupational Health and Safety Administration recommended exposure level of 25 ppm measured for the duration of anesthetic administration. IMPLICATIONS Our results indicate that the levels of nitrous oxide in postanesthesia care units with well maintained, modern ventilation systems are very low. Previous research suggests that the health of workers exposed to these levels should not be adversely affected.

Published
1999

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