జర్నల్ ఆఫ్ అనస్థీషియాలజీ అండ్ పెయిన్ రీసెర్చ్

A narrative review was conducted to examine whether acetaminophen caused upper gastrointestinal complications (UGIC). A small case control study reported that odds ratio (OR) for the risk of upper gastrointestinal (GI) bleeding with was 1.2 (3,250 mg/day) were more likely to experience GI event compared with those who took low-dose acetaminophen (≦ 2,600 mg/day) (RR 1.27: 1.13–1.43 and RR 1.34: 1.15–1.54, respectively). A population-based retrospective cohort study showed that the risk of GI hospitalization was 1.20 (1.03-1.40) during exposure to acetaminophen (>3g/day) compared with the reference category (acetaminophen ≤3 g/day). It is reasonable to judge that acetaminophen>2,000 mg/day causes UGIC. If acetaminophen>2,000 mg/day is administered, gastroprotective agent is probably necessary. We don’t know which gastroprotective agent is optimal. Proton pump inhibitors (PPIs) cause many serious adverse effects. PPIs prevent UGIC due to acetaminophen; however, PPIs exacerbate lower GI complications. If gastroprotective agent is necessary, rebamipide is recommended as a first-line therapy. It is hoped that evidence about these issues will be reported and guidelines will be published.

Ebstein’s anomaly is a rare complex congenital heart disorder with malformation of the tricuspid valve and right ventricle associated with right to left shunt. The disease severity can range from asymptomatic patients to severe debilitated disease. We discuss the anesthetic management of a young female aged 22 years with Ebstein’s anomaly who successfully underwent cystogastomy under general anesthesia. Anesthesia in these patients is fraught with complications and high degree of morbidity and mortality.

Background: The aim of this study was to determine the influence of an active patient blood management (PBM) program in orthopedic surgery in clinical practice at a loco regional hospital.
Methods: After introduction of the PBM program in July 2013, we performed a statistical in-process control for the period between May 2012 and December 2014. The period between May 2012 and June 2013 was before the introduction of the PBM program and the period between July 2013 and December 2014 was after its introduction. During the observation 766 elective orthopedic operations were analyzed (489 hip and 277 knee prostheses). Preoperative anemia, blood transfusion rates and hospital stay were examined.
Results: There was no statistically significant change in preoperative anemia. Using statistical process control (SPC) techniques, we documented an impressive change in the system with a relevant decline of perioperative transfusion rate as a non-random change in the ongoing process. Transfusion probability was reduced risk adjusted by 53% from 7.4% to 3.5% (p=0.008) and length of hospital stay (LOS) dropped, risk adjusted from 9.6 to 9.0 days (p<0.001).
Conclusion: Initiation of a preoperative anemia-correction algorithm within the scope of a PBM-program in clinical routine with the inclusion of general practitioners in a regional hospital was effective in regard to a decrease in blood transfusion risk and in LOS.