The potential use of desmopressin to correct hypothermia-induced impairment of primary haemostasis-An in vitro study using PFA-100®

Objective: Mild hypothermia (32-35 °C) impairs primary haemostasis and coagulation. Correction of these haemostatic impairments by rewarming alone may not be possible or desirable, particularly in major trauma, neuroanaesthesia and in critically ill patients. Pharmacological treatment of these impairments, if available, may be a useful alternative. Desmopressin has been used to treat various congenital and acquired platelet disorders, but its effects on hypothermia-induced impairment of primary haemostasis is not known. This study aims to investigate the in vitro effects of desmopressin on hypothermia-induced impairment of primary haemostasis using PFA-100® platelet function analyzer. Methods: Whole blood was collected from 20 healthy volunteers, divided into 2.7 ml aliquots and some incubated at 32 °C, and others at 37 °C as control. Three log doses of desmopressin (0.01, 0.1 or 1 nM) were added to aliquots at 32 °C, and saline was added to controls at both 32 and 37 °C, all in 0.1 ml volume. After incubating for 30 min, closure times (CT) was measured by PFA-100® using both collagen/epinephrine (adrenaline) (Col/EPI) and collagen/adenosine-5′-diphosphate (Col/ADP) cartridges. Results: CT was prolonged by 30.9% (Col/EPI) and 18.8% (Col/ADP) at 32 °C, respectively, compared to 37 °C (P < 0.001). All the three doses of desmopressin significantly, but incompletely corrected CT prolongation due to hypothermia (P < 0.002). Conclusion: Desmopressin partially reverses hypothermia-induced impairment of primary haemostasis in vitro, and may be potentially useful in improving haemostasis in hypothermic patients with bleeding where immediate rewarming is difficult or undesirable. © 2007 Elsevier Ireland Ltd. All rights reserved.link_to_subscribed_fulltex

A study to assess the dental surgery under local anaesthesia

Organised by the International Federation of Dental Anaesthesiology Societies

A study to assess the value of bispectral analysis in intravenous sedation with midazolam during third molar surgery under local anaesthesia

This study aimed to determine whether bispectral index (BIS) can be used as an indicator of sedation and recovery with intravenous midazolam. In Part A, 30 healthy patients undergoing third molar extraction under local anaesthesia were recruited. They were sedated with intravenous midazolam titrated to clinical endpoints. BIS values were recorded when adequately sedated (BISS) and when clinical recovery criteria were met (BISR). In Part B, another 30 patients were sedated to the range of BISS obtained in Part A. Recovery was assessed postoperatively when the range of BISR from Part A was reached. BIS titrated patients required less midazolam (p < 0.001). Seventy percent of Part B patients required increments of midazolam during surgery, compared to 16.7% in Part A (p < 0.001). Total dose of midazolam given was lower in Part B (p = 0.025). BIS is not effective as a sole indicator of endpoint in sedation with intravenous midazolam. © 2008 The Association of Anaesthetists of Great Britain and Ireland.link_to_OA_fulltex

An audit of postoperative intravenous patient-controlled analgesia with morphine: Evolution over the last decade

The development and refinement of an acute pain service based on the increased availability of clinical evidence would be expected to improve the quality of postoperative pain control. This report reviews the application of postoperative patient-controlled analgesia (PCA) using intravenous morphine in a single institution between 2002 and 2005. More than 5000 patients were evaluated and the results were compared with a similar study performed 10 years ago. Prescription of PCA had increased by more than threefold. Morphine consumption from post-operative day 1 to day 3 (19.1 vs. 26.1, 8.6 vs. 18.1 and 4.5 vs. 19.0 μg/kg/h, respectively), demand-to-delivery ratio (1.35-1.76 vs. 2.4-2.8) and the incidence of respiratory depression (0.06% vs. 2%) were significantly reduced (p < 0.001), but there was no improvement in pain relief. A substantial proportion of patients still experienced postoperative nausea (47%) and vomiting (18.5%) despite a reduction in morphine consumption. Most patients ranked PCA as good and only 0.3% were dissatisfied. We conclude that, in our institution over the last decade, PCA has become more popular for postoperative pain management but with no attendant improvement in pain relief or reduction in side effects. Using PCA alone may result in poorer quality postoperative analgesia. Our findings add to the growing body of evidence that postoperative pain management has not substantially improved despite increased adoption of acute pain services. © 2008 European Federation of Chapters of the International Association for the Study of Pain.link_to_subscribed_fulltex

A comparison of intravenous sedation with dexmedetomidine and midazolam for unilateral third molar extraction under local anaesthesia

Organised by the International Federation of Dental Anaesthesiology Societies.link_to_OA_fulltex