Polymerized bovine hemoglobin solution as a replacement for allogeneic red blood cell transfusion after cardiac surgery: Results of a randomized, double-blind trial

AbstractBackground: Blood loss leading to reduced oxygen-carrying capacity is usually treated with red blood cell transfusions. This study examined the hypothesis that a hemoglobin-based oxygen-carrying solution can serve as an initial alternative to red blood cell transfusion. Methods: In a randomized, double-blind efficacy trial of HBOC-201, a total of 98 patients undergoing cardiac surgery and requiring transfusion were randomly assigned to receive either red blood cell units or HBOC-201 (Hemopure; Biopure Corporation, Cambridge, Mass) for the first three postoperative transfusions. Patients were monitored before and after transfusion, at discharge, and at 3 to 4 weeks after the operation for subsequent red blood cell use, hemodynamics, and clinical laboratory parameters. Results: The use of HBOC-201 eliminated the need for red blood cell transfusions in 34% of cases (95% confidence interval 21%-49%). Patients in the HBOC group received a mean of 1.72 subsequent units of red blood cells; those who received red blood cells only received a mean of 2.19 subsequent units (P =.05). Hematocrit values were transiently lower in the HBOC group but were similar in the two groups at discharge and follow-up. Oxygen extraction was greater in the HBOC group (P =.05). Mean increases in blood pressure were greater in the HBOC group, but not significantly so. Conclusion: HBOC-201 may be an initial alternative to red blood cell transfusions for patients with moderate anemia after cardiac surgery. In a third of cases, HBOC-201 eliminated the need for red blood cell transfusion, although substantial doses were needed to produce this modest degree of blood conservation.J Thorac Cardiovasc Surg 2002;124:35-4

Perioperative Assessment of Patients With Cardiac Implantable Electronic Devices

Worldwide, nearly 4 million patients currently have cardiac implantable electronic devices. Due to the increasing number of candidates to receive either pacemakers or implantable cardiac defibrillators, there is no doubt that primary care physicians or anesthesiologists are very likely to interact and deal with this particular patient population. However, besides technologic advancements, several factors have been frequently reported to cause confusion regarding their perioperative care. Therefore, it has become extremely valuable to understand the basic functions and operation of these devices, as well as their functional limitations, to prevent iatrogenic complications and detect potential failure in an early stage. Mt Sinai J Med 79:25–33, 2012. © 2012 Mount Sinai School of Medicin

Assessment of Depth of Anesthesia During Cardiopulmonary Bypass

Despite recent advances in the anesthetic management of patients undergoing open heart surgery (OHS), little is known concerning depth of anesthesia in the presence of variable surgical stimuli. The present study was designed to evaluate anesthetic depth during hypothermic cardiopulmonary bypass (CPB) utilizing continuous monitoring of lower esophageal contractility (LEC). Tertiary esophageal contractions are stress related, and their presence during cardiopulmonary bypass may indicate inadequate depth of anesthesia. The responses to inappropriate depth of anesthesia may correlate with increased postoperative morbidity or awareness. The present study was designed to evaluate the depth of anesthesia during hypothermic cardiopulmonary bypass and compare lower esophageal contractility (LEC) with other parameters available to assess depth of anesthesia: mean arterial pressure/perfusion flow/temperature and electroencephalogram (EEG) and somatosensory evoked potential (SEP) measurements