Background:Resuscitation with blood products is often required for pediatric cardiac surgery patients following cardiopulmonary bypass. However, data suggest that blood product transfusion is an independent predictor of adverse outcomes. Most studies have specifically found detrimental effects of overall transfusion of red blood cells in particular, but few have analyzed outcomes by the other specific blood product components. Aims:The objective of this study is to analyze adverse outcomes associated with intraoperative transfusion of specific blood product components. Methods:A retrospective review was performed on 643 pediatric patients who underwent cardiac surgery requiring cardiopulmonary bypass to evaluate the risk of selected adverse outcomes associated with intraoperative blood product transfusion. Adverse outcomes included thrombotic complications, stroke, acute kidney injury, prolonged mechanical ventilation, and death. Univariate logistic and linear regression analyses were performed to explore the association between various blood products and the occurrence of postoperative complications.Multiple logistic and linear regression analyses were performed adjusting for age, cyanotic status, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Score (STAT score), and cardiopulmonary bypass time.Results: Unadjusted analysis using univariate logistic and linear regressions showed statistically significant associations of almost all blood components (per 10 mL/kg dose increments) with multiple postoperative complications, including mortality, thrombotic complications, stroke, and days of mechanical ventilation. After adjusting for patient age, cyanotic status, STAT score, and cardiopulmonary bypass time, multivariable logistic and linear regression analyses revealed no association between transfusion of blood products with acute kidney injury and stroke. Administration of red blood cells was the only category significantly correlated with increased days of mechanical ventilation (0.5 days increase in mechanical ventilation per 10 mL/kg transfusion of red blood cells). The only blood product to show complete lack of a statistically significant association with any of the studied outcomes was cryoprecipitate. Conclusions:Transfusion of blood products following cardiopulmonary bypass is associated with postoperative adverse outcomes. Future studies aimed at strategies to reduce intraoperative bleeding and decrease the amount of blood products administered are warranted.
Primary small bowel tumors are uncommon and usually carry a poor prognosis. Adenocarcinoma is the predominant histological type while lymphoma is far less common. Small bowel diffuse large B-cell lymphoma (DLBCL) can mimic adenocarcinoma; thus, the distinction can be challenging before tissue examination is performed. Bowel obstruction, as well as peritoneal involvement, are often seen in gastrointestinal (GI) adenocarcinoma cases; however, these features are extremely uncommon with GI lymphomas. Herein, the authors report an unusual case of an obstructing duodenal mass with peritoneal involvement, which was highly suspicious for an advanced duodenal adenocarcinoma. Surprisingly, sampling of the tumor revealed a diffuse large B-cell lymphoma.
Background: New neurologic deficits after spine surgery occur in less than 1% of cases. A particularly rare complication is white cord syndrome, a neurologic deterioration in the absence of obvious perioperative injury with concurrent hyperintense signal change on T2-weighted magnetic resonance imaging. The pathophysiologic mechanism is hypothesized to be an ischemiareperfusion injury after the decompression of a chronically ischemic cord. Case Report: A 63-year-old male underwent posterior cervical decompression and fusion for severe cervical stenosis and myelopathy. During the procedure, intraoperative neurophysiologic monitoring signals were lost. The patient developed acute postoperative tetraplegia attributed to white cord syndrome. Motor and sensory deficits improved after intravenous dexamethasone and intensive physical therapy. Conclusion: The pathophysiology of white cord syndrome is unclear, and intraoperative anesthetic management strategies to prevent this syndrome are unknown. This case serves to educate perioperative physicians to suspect this rare syndrome, encourage research into its pathophysiology, and guide clinicians in formulating therapeutic regimens.
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