This retrospective analysis suggests that PCC may be an alternative to FFP in patients previously treated with warfarin who are coagulopathic after major cardiac surgery. Randomized controlled studies powered to evaluate efficacy and important postoperative outcomes for patients receiving PCC versus FFP for coagulopathic bleeding after cardiopulmonary bypass are warranted.

T he widely used first-generation 5-hydroxytryptamine type 3 (5-HT 3 ) receptor antagonists are associated with cardiovascular adverse events. The cause of these complications is thought to be a tendency to block cardiac potassium and sodium ion channels, leading to increasing corrected QT (QTc) intervals. Palonosetron is a second-generation 5-HT 3 receptor antagonist used to prevent postoperative nausea and vomiting (PONV). However, it may prolong the QTc interval and increase the risk of life-threatening arrhythmias. Sevoflurane induces QTc interval prolongation by inhibition of cardiac potassium ion channels similar to the mechanism of the first-generation 5-HT 3 receptor antagonists. If palonosetron and sevoflurane have a combined effect on cardiac ion channels, palonosetron may induce QTc interval prolongation under sevoflurane anesthesia. This prospective, randomized, double-blind study was undertaken to evaluate the effects of palonosetron on QTc intervals in patients having elective surgery under sevoflurane anesthesia.The 100 patients, aged 20 to 75 years, were having elective abdominal or gynecologic surgery with an expected duration of more than 1.5 hours. The presurgery group of 50 patients received 0.075 mg palonosetron intravenously immediately before induction of general anesthesia and 1.5 mL normal saline intravenously immediately after the first postoperative QTc interval was recorded in the recovery room. The postsurgery group of 50 patients received 1.5 mL normal saline before anesthesia induction and 0.075 mg palonosetron intravenously immediately after the first postoperative QTc interval was recorded in the recovery room. Corrected QT intervals were measured before operation, intraoperatively (baseline, immediately after tracheal intubation, and at 2, 10, 25, 30, 60, and 90 minutes after administration of palonosetron or placebo), and after surgery (before and at 3 and 10 minutes after palonosetron or placebo administration). Corrected QT intervals were calculated using Bazett (QTcB), Fridericia (QTcF), or Hodges (QTcH) formulas. The incidence of PONV was assessed at 0 to 2 and 2 to 24 hours after surgery. A complete response was defined as an absence of both emetic episodes and the use of rescue medications for PONV. The primary outcome was the QTcF interval measured immediately after tracheal intubation. SPSS for Windows version 18.0 (SPSS Inc, Chicago, Ill) was used for statistical analyses. P < 0.05 indicated statistical significance.The 2 groups did not differ in patient characteristics or in preoperative QTc intervals on electrocardiograms. Serum electrolyte levels, end-tidal concentrations of sevoflurane, and perioperative differences in heart rate or mean arterial pressure changes did not differ between the 2 groups. No differences were noted in perioperative QTc changes over time between the 2 groups, regardless of the calculation methods (Bazett, P = 0.87; Fridericia, P = 0.75; Hodges, P = 0.87). The perioperative QTcF or QTcH intervals were increased at all time points compared wi...

The combination of surgical PEA and interventional BPA is a new treatment option for highly selected high-risk CTEPH patients. A multidisciplinary CTEPH expert team is a basic pre-requisite for this complex concept.

Functional iron deficiency was the most common cause of anaemia but was not associated with outcome. The only haematological parameter that was associated with outcome was hepcidin concentration, which is a novel finding and introduces further complexity into our understanding of the role of iron and its regulation by hepcidin. We propose that future research should target patients with elevated hepcidin.

Antifibrinolytic drugs have become almost ubiquitous in their use during major surgery when bleeding is expected or commonplace. Inhibition of the fibrinolytic pathway after tissue injury has been consistently shown to reduce postoperative or traumatic bleeding. There is also some evidence for a reduction of perioperative blood transfusion. However, evidence of complications associated with exaggerated thrombosis also exists, although this appears to be influenced by the choice of the individual agent and the dose administered. There is controversy over the use of the serine protease inhibitor aprotinin, whose license was recently withdrawn but may shortly become available on the market again. In the UK, tranexamic acid, a tissue plasminogen and plasmin inhibitor, is most commonly used, with evidence for benefit in cardiac, orthopaedic, urological, gynaecological, and obstetric surgery. In the USA, ε-aminocaproic acid, which also inhibits plasmin, is commonly used. We have reviewed the current literature for this increasingly popular class of drugs to support clinical judgement in daily anaesthetic practice.