[Rational transfusion therapy. A study of transfusion practice and possibilities of optimization in elective coronary bypass surgery]. / Rationel transfusionsbehandling. En undersøgelse of transfusionspraksis og muligheder for at optimere denne ved elektiv koronar bypass-kirurgi.

The objective of the study was to evaluate the effect of intervention on physicians' transfusion behavior in elective coronary artery bypass grafting (CABG). We analyzed transfusion data on 176 patients who underwent primary elective CABG during two periods, either before (phase one, n = 102) or after (phase two, n = 74) intervention. The intervention was based on cooperation with the involved department of cardiac surgery, interviews of the surgeons and anaesthesiologists ordering blood, and concurrent audit of transfusion practice using a blood order form. The proportion af patients receiving allogenic transfusions decreased from 90% in phase one to 58% in phase two and the total use of blood components was reduced from an average of 6.3 units/patient to 2.7 units/patient, p < 0.01. Indications for transfusion documented in the medical record increased from 19% in phase one to 63% in phase two. It is concluded that intervention on physicians' transfusion behavior can improve the transfusion therapy in patients who undergo elective CABG.

Halothane hepatitis after jejunoileal bypass.

A case of halothane hepatitis occurring 14 months after jejunoileal bypass for morbid obesity in a 49-year-old woman is described. Hepatic dysfunction after bypass procedures is especially seen in the weight losing phase, and has been ascribed to protein malnutrition. Halothane is considered immunogenic and it is possible that the hepatitis was provoked by repeated halothane administrations due to the patient's altered immunological competence.

Local reactions to i.v. diazepam in three different formulations.

Local venous reactions during and after i.v injections of three different formulations of diazepam were studied in 200 patients undergoing gastroscopy. Of the patients receiving diazepam in propylene glycol (Stesolid) 78% experienced pain on injection and 48% subsequently developed clinical evidence of thrombophlebitis. The figures for Stesolid MR (diazepam in Cremophor EL) were 38% and 9% respectively. A significant decrease was achieved (pain on injection 1%; clinical thrombophlebitis 4%) when using Diazemuls, a new formulation in which diazepam is dissolved in oil and emulsified in water. Since no difference in the therapeutic effect of the different formulations was observed, Diazemuls represents a clear advantage to Stesolid and Stesolid MR.

Sublingual flunitrazepam for premedication.

The clinical effects of a standard 2 mg flunitrazepam tablet given sublingually for premedication were evaluated in a group of 50 patients undergoing otorhinolaryngologic surgery. A comparable group of 49 patients received 10 mg of diazepam orally. The degree of sedation and anxiety was assessed objectively and subjectively before induction of anaesthesia. Flunitrazepam produced better sedation judged by the observer as well as by the patients. There was less anxiety in the flunitrazepam group but this was not statistically significant. Side effects were few and patient acceptability high. Sublingual premedication using flunitrazepam could be a useful alternative to other forms of premedication.