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New oral anticoagulants in perioperative medicine.
Abstract New oral anticoagulants (NOAC) inhibit factor Xa (Stuart-Prower factor) or factor IIa (thrombin) and are alternatives to vitamin K antagonists. Perioperative indications are deep vein thrombosis prophylaxis for prosthetic hip and knee replacement, therapeutic anticoagulation for deep vein thrombosis as well as the prophylaxis of stroke for patients with atrial fibrillation. Patients on NOACs pose multiple perioperative challenges for all medical disciplines involved. For non-emergency surgery, patients should be evaluated by an anesthesiolgist as early as possible to assess an optimal appointment for surg...
Source: Der Anaesthesist - April 4, 2014 Category: Anesthesiology Authors: Giebl A, Gürtler K Tags: Anaesthesist Source Type: research

Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock
ConclusionsIn this SV‐guided bleeding and fluid resuscitation model, both ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2 may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.
Source: Acta Anaesthesiologica Scandinavica - March 19, 2014 Category: Anesthesiology Authors: M. NÉMETH, K. TÁNCZOS, G. DEMETER, D. ÉRCES, J. KASZAKI, A. MIKOR, Z. MOLNÁR Tags: Original Article Source Type: research

Black Box Warning: Is Ketorolac Safe for Use After Cardiac Surgery?
Objective: In 2005, after the identification of cardiovascular safety concerns with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), the FDA issued a black box warning recommending against the use of NSAIDs following cardiac surgery. The goal of this study was to assess the postoperative safety of ketorolac, an intravenously administered NSAID, after cardiac surgery.Design: Retrospective observational study.Setting: Single center, regional hospital.Participants: A total of 1,309 cardiac surgical patients (78.1% coronary bypass, 28.0% valve) treated between 2006 and 2012.Interventions: A total of 488 of these patie...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 13, 2013 Category: Anesthesiology Authors: Lisa Oliveri, Katie Jerzewski, Alexander Kulik Tags: Original Articles Source Type: research

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting
Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with an...
Source: Anesthesiology - April 23, 2013 Category: Anesthesiology Tags: Education: Review Article Source Type: research

Challenges After the First Decade of Transcatheter Aortic Valve Replacement: Focus on Vascular Complications, Stroke, and Paravalvular Leak
Transcatheter aortic valve replacement (TAVR) is entering its second decade. Three major clinical challenges have emerged from the first decade of experience: vascular complications, stroke, and paravalvular leak (PVL). Major vascular complications remain common and independently predict major bleeding, transfusion, renal failure, and mortality. Although women are more prone to vascular complications, overall they have better survival than men. Further predictors of major vascular complications include heavily diseased femoral arteries and operator experience. Strategies to minimize vascular complications include a multimo...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 12, 2012 Category: Anesthesiology Authors: Christopher Reidy, Aris Sophocles, Harish Ramakrishna, Kamrouz Ghadimi, Prakash A. Patel, John G.T. Augoustides Tags: Expert Review Source Type: research

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