Outcomes and biochemical parameters following cardiac surgery: effects of transfusion of residual blood using centrifugation and multiple-pass hemoconcentration.

OBJECTIVES: To determine whether or not there was a significant difference between the methods of centrifugation (CF) and multiple-pass hemoconcentration (MPH) of the residual cardiopulmonary-bypass volume in relation to biochemical measurements and patient outcomes. DESIGN: Prospective, randomized, and controlled. SETTING: Conducted at a western Canadian tertiary care hospital. PARTICIPANTS: Consisted of 61 consecutive male and female patients from ages 40 to 80 who were scheduled for cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: Either the centrifugation or multiple-pass hemoconcentration method was used to process the residual blood from the cardiopulmonary bypass circuit. RESULTS: The 12-hour postoperative levels of serum hemoglobin were not significantly different in the centrifugation group as compared to the multiple-pass hemoconcentration group. However, the serum levels of total protein and albumin were significantly higher in the multiple-pass hemoconcentration group as compared to the centrifugation group. Additionally, after 12-hours postoperatively, the serum fibrinogen and platelet counts were significantly higher in the multiple-pass hemoconcentration group as compared to those of the centrifugation group. The allogeneic product transfusion index and the chest-tube blood drainage indices were lower in the multiple-pass hemoconcentration group as compared to the centrifugation group. CONCLUSION: Although the CF method provided a product in a shorter turnaround time, with consistent clearance of heparin, the MPH method trended towards enhanced biochemical and clinical patient outcomes over the 12-hour postoperative period.

Bispectral analysis during procedural sedation in the pediatric emergency department.

OBJECTIVE: Our primary objective was to determine the maximum depth of sedation achieved, as measured by the bispectral (BIS) index monitor, for pediatric patients undergoing procedural sedation in a pediatric emergency department. METHODS: This prospective, blinded, observational study was conducted in a tertiary pediatric emergency department. Procedural sedation and analgesia were performed in the standard manner, with the addition of blinded BIS index monitoring. In addition, both the sedating physician and the procedural physician recorded their clinical impression of the maximum depth of sedation. RESULTS: A convenience sample of 50 patients was enrolled. The median age was 9.2 years (range, 3-15 y). The mean nadir BIS index was 43.1 ± 17.4 (SD), with a 95% confidence interval from 37.8 to 48.4. This was significantly lower than the BIS index value that is considered to reflect general anesthesia (<60; P > 0.0001). Almost 80% of the analyzed patient sedations were classified as having achieved general anesthesia. When comparing the sedating physician and the procedural physician's clinical assessment of maximal depth of sedation with the nadir BIS index value, there was only slight agreement between the 2 groups (κ statistics, 0.19 and 0.057, respectively). Ninety-three percent of the sedating physicians and 88% of the procedural physicians underestimated the maximum depth of sedation of their patients. CONCLUSIONS: This study suggests that most pediatric procedural sedation patients spend at least a period in a general anesthetic state. During most procedural sedation, the physicians involved are likely underestimating the maximal depth of sedation for their patients.