Best Practice & Research-Clinical Anaesthesiology最新文献_第10页

ESAs in perioperative anemia management: Who, what, how and why? esa在围手术期贫血管理中的作用：谁，什么，如何以及为什么？

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2023-10-17 DOI: 10.1016/j.bpa.2023.10.002

Sigismond Lasocki , Maëva Campfort , Maxime Leger , Emmanuel Rineau

{"title":"ESAs in perioperative anemia management: Who, what, how and why?","authors":"Sigismond Lasocki , Maëva Campfort , Maxime Leger , Emmanuel Rineau","doi":"10.1016/j.bpa.2023.10.002","DOIUrl":"10.1016/j.bpa.2023.10.002","url":null,"abstract":"<div><div>Preoperative anemia is frequent and is associated with poor patient outcomes and higher transfusion rates. Perioperative blood transfusion is also associated with poor outcomes. These observations justify efforts to increase hemoglobin levels in anemic patients before surgeries with a moderate to high bleeding risk.</div><div>Erythropoiesis-stimulating agents (ESAs) were developed in the 80s and are now widely used for the treatment of renal and cancer-related anemia. In the perioperative settings, ESAs were successfully proposed for preoperative blood donation programs in the 90s. Since then, substantial evidence has been available demonstrating that high-dose ESAs associated with iron (ideally intravenously), administered 3–4 weeks before surgery, increase perioperative hemoglobin levels and reduce the need for blood transfusion in some surgeries. Different strategies might be proposed ranging from a systematic treatment for all patients with hemoglobin below 13 g/dL (especially in orthopedic and cardiac surgeries) to a more personalized approach to anemia treatment (targeting anemia related to inflammation or renal insufficiency). ESAs might increase the risk of adverse events, including thromboembolism, and the benefit-risk ratio must be carefully weighted for high-risk patients (particularly for those undergoing cancer surgery). The cost-effectiveness of ESA use remains to be evaluated.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 519-526"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135809603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intra-operative tranexamic acid: A standard of care? 术中使用氨甲环酸：护理标准？

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2023-12-12 DOI: 10.1016/j.bpa.2023.11.006

Nicole Relke , Grace H. Tang , Michelle Sholzberg

引用次数: 0

Does one unit really matter? Immunological effects of transfusion after universal leucodepletion 一个单位真的重要吗？输注对白细胞普遍清除后的免疫效应

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2023-10-21 DOI: 10.1016/j.bpa.2023.10.004

Arun Muthukumar , Juan Jose Guerra-Londono , Juan P. Cata

{"title":"Does one unit really matter? Immunological effects of transfusion after universal leucodepletion","authors":"Arun Muthukumar , Juan Jose Guerra-Londono , Juan P. Cata","doi":"10.1016/j.bpa.2023.10.004","DOIUrl":"10.1016/j.bpa.2023.10.004","url":null,"abstract":"<div><div><span><span>Patients with cancer who receive allogeneic red blood cell transfusions are at risk of </span>adverse reactions of varying severity. One of these reactions is </span>immunomodulation<span><span>, also known as transfusion-related immunomodulation. With the exact mechanism of transfusion related immunomodulation being unclear, storage lesions (both the cellular and cytokine component) are considered a major contributor. Leucocytes are believed to be implicated in storage lesions and immunomodulation. However, the efficacy of leucodepletion in reducing immunomodulation is controversial. The theoretical link between these three interconnected events - storage lesions, immunomodulation and cancer progression remain controversial and poorly understood. This article summarizes the available evidence on efficacy of leucodepletion, storage lesions and transfusion related immunomodulation, while rationalizing the possible association between an immunomodulation triggering transfusion ‘dose’ in cancer patients and subsequent </span>cancer recurrence.</span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 495-502"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How low can you go: Restrictive transfusion strategies in major surgery and physiological triggers 你能做到多低：在大手术和生理诱因下的限制性输血策略

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2023-12-07 DOI: 10.1016/j.bpa.2023.11.005

Gregory MT Hare , Ahmad Alli , Helen Jiang , C David Mazer

{"title":"How low can you go: Restrictive transfusion strategies in major surgery and physiological triggers","authors":"Gregory MT Hare , Ahmad Alli , Helen Jiang , C David Mazer","doi":"10.1016/j.bpa.2023.11.005","DOIUrl":"10.1016/j.bpa.2023.11.005","url":null,"abstract":"<div><div>Anemia and red blood cell transfusion<span><span> are associated with adverse outcomes. Large randomized trials have demonstrated that restrictive transfusion strategies can safely reduce patient exposure to transfusion, forming a foundational pillar of patient blood management. The restrictive transfusion thresholds in these trials ranged from 7 to 8 g/dL for different populations and this variability is reflected in recent guideline recommendations for transfusion triggers. Such variability implies heterogeneity among populations with respect to the transfusion threshold for optimal outcomes. Individual variability (tolerance to anemia, risk of </span>tissue hypoxia, risk of red blood cell transfusion) has not been addressed by population-based trials, supporting the argument for ‘physiological transfusion triggers’ indicative of inadequate organ perfusion. However, physiological triggers have only been assessed in small feasibility trials without convincing outcome data. This review summarizes data from recent transfusion trials and transfusion guidelines, and reviews potential physiological triggers which could further refine transfusion practices and minimize risks of tissue hypoxia and adverse outcomes.</span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 477-485"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143234801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnosing iron deficiency: Controversies and novel metrics 诊断缺铁症：争议与新指标

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2023-11-17 DOI: 10.1016/j.bpa.2023.11.001

Jody A. Rusch , Diederick J. van der Westhuizen , Robert S. Gill , Vernon J. Louw

{"title":"Diagnosing iron deficiency: Controversies and novel metrics","authors":"Jody A. Rusch , Diederick J. van der Westhuizen , Robert S. Gill , Vernon J. Louw","doi":"10.1016/j.bpa.2023.11.001","DOIUrl":"10.1016/j.bpa.2023.11.001","url":null,"abstract":"<div><div>Iron deficiency, a pervasive global health issue, necessitates precise and reliable diagnostic methods, especially in clinical and surgical settings. This review examines an array of established markers of iron status, encapsulating parameters such as serum iron, ferritin, transferrin, and transferrin saturation alongside novel biomarkers like soluble transferrin receptor, zinc protoporphyrin, and hepcidin. We further scrutinise the potential and limitations of routine and novel diagnostic tools and strategies in distinguishing different anaemic conditions, such as iron deficiency anaemia, iron-restricted erythropoiesis, and anaemia of inflammation. Through a critical lens, we elucidate the current paradigms and pressing questions surrounding the diagnostic criteria and clinical ramifications of iron metabolism. By weaving together the nuances and diverging perspectives within the domain of iron deficiency diagnosis and management, this review aspires to foster a clearer understanding that can steer improved patient care and shape the trajectory of future research in this vital field.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 451-467"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139305617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Magic in a bottle? A Focused review of factor concentrates for the intraoperative treatment of acquired coagulopathy – Fibrinogen concentrate, prothrombin complex concentrate, and recombinant activated factor VII 瓶子里的魔法？术中治疗获得性凝血病的浓缩因子——纤维蛋白原浓缩物、凝血酶原复合浓缩物和重组活化因子VII的重点综述

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2023-11-14 DOI: 10.1016/j.bpa.2023.11.003

Amir Zabida , Justyna Bartoszko , Keyvan Karkouti

{"title":"Magic in a bottle? A Focused review of factor concentrates for the intraoperative treatment of acquired coagulopathy – Fibrinogen concentrate, prothrombin complex concentrate, and recombinant activated factor VII","authors":"Amir Zabida , Justyna Bartoszko , Keyvan Karkouti","doi":"10.1016/j.bpa.2023.11.003","DOIUrl":"10.1016/j.bpa.2023.11.003","url":null,"abstract":"<div><div>Goal-directed administration of blood components including red cells, platelets, plasma, and factor concentrates plays a critical role in the management of intraoperative coagulopathy<span>. Increasingly commonly used, purified and recombinant factor concentrates are being recognized for their logistical advantages and potentially superior efficacy. Three- and four-factor prothrombin<span> concentrates, fibrinogen concentrates<span> and activated factor VII have an evolving evidence base relative to frozen plasma and cryoprecipitate. This review discusses these compounds, compares them to conventional blood products, discusses the trial data supporting their use, and reviews indications for intraoperative transfusion based on point-of-care testing and conventional laboratory results. While factor concentrates have become an increasingly popular option for treating acquired factor deficiency in surgical patients, evidence is evolving and clinical trial data in one surgical patient population may not be transferable to another. High quality clinical studies will help optimize management of coagulopathy and improve patient outcomes while decreasing any associated risks.</span></span></span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 527-536"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135716959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patient blood management 患者血液管理

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2024-01-05 DOI: 10.1016/j.bpa.2024.01.001

Lachlan F. Miles

引用次数: 0

Postoperative anaemia: Hiding in plain sight 术后贫血：隐藏在视线之中

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2023-11-10 DOI: 10.1016/j.bpa.2023.11.002

Ethan H. Crispell , Jessica Trinh , Matthew A. Warner

引用次数: 0

Does patient blood management represent good value for money? 患者血液管理是否物有所值？

IF 4.7 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-12-01 Epub Date: 2023-11-11 DOI: 10.1016/j.bpa.2023.11.004

Adam Irving , Zoe K. McQuilten

引用次数: 0

The patient with congenital heart disease in ambulatory surgery 门诊手术中的先天性心脏病患者

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-09-01 Epub Date: 2022-12-08 DOI: 10.1016/j.bpa.2022.11.006

Gert-Jan Eerdekens (MD, Anesthesia Consultant) , Dieter Van Beersel (MD, PhD-Student, Anesthesia Consultant) , Steffen Rex (MD, PhD, Associate Professor, Head of the Anesthesia Department) , Marc Gewillig (MD, PhD, Professor, Pediatric Cardiologist) , An Schrijvers (MD, Anesthesia Consultant) , Layth AL tmimi (MD, PhD, Associate Professor, Anesthesia Consultant)

{"title":"The patient with congenital heart disease in ambulatory surgery","authors":"Gert-Jan Eerdekens (MD, Anesthesia Consultant) , Dieter Van Beersel (MD, PhD-Student, Anesthesia Consultant) , Steffen Rex (MD, PhD, Associate Professor, Head of the Anesthesia Department) , Marc Gewillig (MD, PhD, Professor, Pediatric Cardiologist) , An Schrijvers (MD, Anesthesia Consultant) , Layth AL tmimi (MD, PhD, Associate Professor, Anesthesia Consultant)","doi":"10.1016/j.bpa.2022.11.006","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.11.006","url":null,"abstract":"<div><p><span>The number of patients with congenital heart disease (CHD) undergoing </span>ambulatory surgery<span> is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists’ Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator.</span></p><p>Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 421-436"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0