Preoperative hematocrit and platelet count are associated with blood loss during spinal fusion for children with neuromuscular scoliosis.

AIM: To assess the relationship of preoperative hematology laboratory results with intraoperative estimated blood loss and transfusion volumes during posterior spinal fusion for pediatric neuromuscular scoliosis. METHODS: Retrospective chart review of 179 children with neuromuscular scoliosis undergoing spinal fusion at a tertiary children's hospital between 2012 and 2017. The main outcome measure was estimated blood loss. Secondary outcomes were volumes of packed red blood cells, fresh frozen plasma, and platelets transfused intraoperatively. Independent variables were preoperative blood counts, coagulation studies, and demographic and surgical characteristics. Relationships between estimated blood loss, transfusion volumes, and independent variables were assessed using bivariable analyses. Classification and Regression Trees were used to identify variables most strongly correlated with outcomes. RESULTS: In bivariable analyses, increased estimated blood loss was significantly associated with higher preoperative hematocrit and lower preoperative platelet count but not with abnormal coagulation studies. Preoperative laboratory results were not associated with intraoperative transfusion volumes. In Classification and Regression Trees analysis, binary splits associated with the largest increase in estimated blood loss were hematocrit ≥44% vs. <44% and platelets ≥308 vs. <308 × 109/L. CONCLUSIONS: Preoperative blood counts may identify patients at risk of increased bleeding, though do not predict intraoperative transfusion requirements. Abnormal coagulation studies often prompted preoperative intervention but were not associated with increased intraoperative bleeding or transfusion needs.

Age differences in output-monitoring accuracy.

Output monitoring refers to memory for whether an intended action has been completed. Failures in output monitoring can lead to action repetitions or action omissions. Output monitoring is difficult for both younger and older adults, but few studies have examined age differences in output monitoring. Two experiments using a picture-based prospective memory task with an output-monitoring component were conducted to investigate the role of increased contextual detail and pre-exposure on output-monitoring accuracy in younger and older adults. Across the two experimental manipulations older adults demonstrated less accurate output monitoring by primarily committing errors of repetition. Pre-exposure to targets resulted in worse output-monitoring accuracy for both younger and older adults.

The joys of perioperative nursing.

When we join perioperative nursing we enter the swinging doors of the operating suite and never leave. Have we come home? Are we drawn by--Student experience? A job to go to by random assignment? A long desire to work in the OR? For a career change? Regardless of the reason for our arrival, many things keep us in the OR including the teamwork, friendships formed, the challenges, the camaraderie, and the constant learning of new skills. For some it is the adrenaline rushes with each crisis and trauma that comes through the door. Or maybe it's because we feel we truly are nursing and able to act for the patient. We realize that patients have placed their trust in our care during a very vulnerable time when they are unable to speak for themselves. What creates and keeps a perioperative nurse? Using a qualitative research questionnaire, given to nurses attending a national perioperative conference, the author obtained feedback from nurses on their feelings, attitudes and knowledge in an effort to determine what makes a perioperative nurse and what it is that keeps them there for so many years. The results, along with the author's personal observations, are outlined in this article.