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BACKGROUND Management of coagulopathy during major oncologic surgery can be multifactorial and challenging. Viscoelastic assays (VEAs) can be useful in providing vital data about the mechanism of coagulopathy in these dynamic circumstances. OBJECTIVES A prospective nonrandomized observational study with the aim of describing the coagulation parameters of patients undergoing major oncologic surgery using the Quantra® and TEG® 5000 systems. Our secondary objectives included the correlation between Quantra and TEG parameters, and the times to result for both technologies. METHODS This study included 74 adults undergoing oncologic surgery with an anticipated blood loss of more than 500 ml. For each subject, whole blood samples for each device were collected at multiple points perioperatively for comparison. RESULTS Correlation coefficients between Quantra and TEG parameters were 0.8 and above, indicating a very strong correlation (p

Accurate measurement of intraoperative blood loss is an important clinical variable in managing fluid resuscitation and avoiding unnecessary transfusion of blood products. In this study, blood lost onto laparotomy sponges during surgical cases was measured using a tablet computer programmed with a unique algorithm modeled after facial recognition technology. In this study, we assessed the accuracy and performance of the system in surgical cases.In this prospective, multicenter study, 46 patients undergoing surgery with anticipated significant blood loss contributed laparotomy sponges for hemoglobin (Hb) loss measurement using the Triton System with Feature Extraction Technology (Gauss Surgical, Inc., Los Altos, CA). The Hb loss measured by the new system was compared with that measured by manual rinsing of the sponges. Accuracy was evaluated using linear regression and Bland-Altman analysis. In addition, the new system's calculation of blood volume loss was compared with the gravimetric method of estimating blood loss from intraoperative sponge weights.A significant positive linear correlation was noted between the new system's measurements and the rinsed Hb mass (r = 0.93, P0.0001). Bland-Altman analysis revealed a bias of 9.0 g and narrow limits of agreement (-7.5 to 25.5 g) between the new system's measures and the rinsed Hb mass. These limits were within the clinically relevant difference of ±30 g, which is approximately half of the Hb content of a unit of allogeneic whole blood. Bland-Altman analysis of the estimated blood loss on sponges using the gravimetric method demonstrated a bias of 466 mL (overestimation) with limits of agreement of -171 and 1103 mL, due to the presence of contaminants other than blood on the laparotomy sponges.The novel mobile monitoring system provides an accurate measurement of Hb mass on surgical sponges as compared with that of manual rinsing measurements and is significantly more accurate than the gravimetric method. Further study is warranted to assess the clinical use of the technology.

Background and purpose Physicians responsible for anesthesia and/or sedation (A/S) at emerging proton radiation therapy centers (PTCs) seek information about practices at established centers. We conducted a survey of A/S practices at established PTCs to provide this information for physicians at new PTCs. Methods and materials A web-based survey was sent to physicians responsible for A/S at 37 established PTCs. Questions were based on practice patterns and the preferred method of A/S delivery during proton-radiation therapy. One representative per institution was surveyed. Results A response rate of 38%, with a combined case load of more than 15,000 anesthetics per year was obtained. Children younger than 4 years old often (72%) required A/S. The most favored A/S techniques involved total intravenous anesthesia with propofol and an unprotected airway (57%) or general anesthesia with sevoflurane and a laryngeal mask airway (36%). It was notable that 21% of facilities did not have dedicated recovery rooms. Also, anesthesia gas evacuation outlets were absent at 43% of treatment rooms. Conclusions A/S is commonly delivered to patients undergoing proton radiation therapy, most often with total intravenous anesthesia. To avert potential obstacles to the safe delivery of care, anesthesiologists at emerging centers are encouraged to participate throughout the design and planning phases of new PTCs.

Microscopic polyangiitis and granulomatosis with polyangiitis are rare anti-neutrophilic cytoplasmic antibody-associated systemic vasculitides that predominantly affect small to medium sized vessels of the lungs and kidneys. These syndromes are largely confined to older adults and often present sub-acutely following weeks to months of nonspecific prodromal symptoms. While both diseases often manifest within multiple organ systems concurrently, the disease spectrum of microscopic polyangiitis almost always includes the kidneys, while granulomatosis with polyangiitis is most commonly associated with pulmonary disease. We present two cases of rapid onset respiratory failure secondary to diffuse alveolar hemorrhage in young active duty military personnel. After serological testing and surgical lung biopsy, both patients were diagnosed with microscopic polyangiitis with isolated pulmonary involvement.