21 research outputs found
Haematoma, abscess or meningitis after neuraxial anaesthesia in the USA and the Netherlands: A closed claims analysis
BACKGROUND: Severe complications after neuraxial anaesthesia are rare but potentially devastating. OBJECTIVE: We aimed to identify characteristics and preventable causes of haematoma, abscess or meningitis after neuraxial anaesthesia. DESIGN: Observational study, closed claims analysis. SETTING: Closed anaesthesia malpractice claims from the USA and the Netherlands were examined from 2007 until 2017. PATIENTS: Claims of patients with haematoma (n = 41), abscess (n = 18) or meningitis (n = 14) associated with neuraxial anaesthesia for labour, acute and chronic pain that initiated and closed between 2007 and 2017 were included. There were no exclusions. MAIN OUTCOME MEASURES: We analysed potential preventable causes in patient-related, neuraxial procedure-related, treatment-related and legal characteristics of these complications. RESULTS: Patients experiencing spinal haematoma were predominantly above 60 years of age and using antihaemostatic medication, whereas patients with abscess or meningitis were middle-aged, relatively healthy and more often involved in emergency interventions. Potential preventable causes of unfavourable sequelae constituted errors in timing/prescription of antihaemostatic medication (10 claims, 14%), unsterile procedures (n = 10, 14%) and delay in diagnosis/treatment of the complication (n = 18, 25%). The number of claims resulting in payment was similar between countries (USA n = 15, 38% vs. the Netherlands n = 17, 52%; P = 0.25). The median indemnity payment, which the patient received varied widely between the USA (&OV0556;285 488, n = 14) and the Netherlands (&OV0556;31 031, n = 17) (P = 0.004). However, the considerable differences in legal systems and administration of expenses between countries may make meaningful comparison of indemnity payments inappropriate. CONCLUSIONS: Claims of spinal haematoma were often related to errors in antihaemostatic medication and delay in diagnosis and/or treatment. Spinal abscess claims were related to emergency interventions and lack of sterility. We wish to highlight these potential preventable causes, both when performing the neuraxial procedure and during postprocedural care of patients
Adhesion of Blood Plasma Proteins and Platelet-rich Plasma on <i><i>l</i></i>‑Valine-Based Poly(ester urea)
The
competitive absorption of blood plasma components including
fibrinogen (FG), bovine serum albumin (BSA), and platelet-rich plasma
(PRP) on <i><i>l</i></i>-valine-based polyÂ(ester urea) (PEU) surfaces were
investigated. Using four different PEU polymers, possessing compositionally
dependent trends in thermal, mechanical, and critical surface tension
measurements, water uptake studies were carried out to determine <i>in vitro</i> behavior of the materials. Quartz crystal microbalance
(QCM) measurements were used to quantify the adsorption characteristics
of PRP onto PEU thin films by coating the surfaces initially with
FG or BSA. Pretreatment of the PEU surfaces with FG inhibited the
adsorption of PRP and BSA decreased the absorption 4-fold. <i>In vitro</i> studies demonstrated that cells cultured on <i><i>l</i></i>-valine-based PEU thin films allowed attachment
and spreading of rat aortic cells. These measurements will be critical
toward efforts to use this new class of materials in blood-contacting
biomaterials applications