PubMed Health⌕ Search

Biomedical subjects

P Wajon

Publications and source records attributed to P Wajon.

8 recordsLinked to original sources
PubMed2001

Intraoperative plateletpheresis and autologous platelet gel do not reduce chest tube drainage or allogeneic blood transfusion after reoperative coronary artery bypass graft.

Platelet-rich plasma (PRP) is postulated to decrease postoperative mediastinal chest tube drainage (MCTD) and allogeneic blood transfusions (ABT) after surgery with cardiopulmonary bypass. However, recent metaanalysis of the literature reveals that few good quality (therapeutic yield) trials that show a benefit have been published. The potential hemodynamic instability caused by plateletpheresis has not been emphasized. We studied the effect of plateletpheresis on MCTD, ABT, and hemodynamic stability in reoperative coronary artery bypass graft patients, a group perceived to be at high risk for ABT. Ninety patients were randomly assigned to Pheresis or Control groups. epsilon-Aminocaproic acid was given to all patients. Hemodynamic instability was assessed by degree of volume and inotrope resuscitation required. Part of the sequestered platelet volume was used to make autologous platelet gel, which was applied as a wound sealant. Mean pheresis yield was 30% +/- 7% of the circulating platelet mass or 6.4 +/- 2.2 allogeneic platelet unit equivalents. Total MCTD did not differ between the groups. There were no differences in mean packed red blood cell, platelet, and plasma transfusion rates. Overall, 52% of the Pheresis group received ABT, versus 55% of the Control group. Fifty-three percent of the Pheresis group patients exhibited significant hemodynamic instability, versus 27% of the Control group (P < 0.05). This study was unable to show any reduction in MCTD or ABT, although the plateletpheresis technique may offset platelet dysfunction caused by aspirin or increased blood exposure to nonbiologic surfaces, or it may compensate for lack of antifibrinolytic use. The significantly increased incidence of hemodynamic instability in the Pheresis group means that the risk/benefit ratio must be determined for individual cardiac surgical units.

Aged↗
PubMed1998

Detection of postoperative myocardial ischemia by bedside ST-segment analysis in coronary artery bypass graft patients.

OBJECTIVE: To determine if the ST-segment monitoring software of a bedside electrocardiograph (ECG) monitor would detect postoperative myocardial ischemia (POMI) as reliably as the clinical gold standard 12-lead ECG, and to compare the characteristics of ischemia thus detected with prior studies performed using Holter monitoring. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: One hundred patients who had undergone coronary artery bypass grafting (CABG). INTERVENTIONS: Continuous ST-segment trends in leads II and V5 were recorded using Hewlett-Packard Merlin monitors postbypass until discharge from the postsurgical unit, and printouts were analyzed for episodes of ischemia. Simultaneous 12-lead ECGs and monitor strips were recorded during ischemic episodes in 24 patients and were independently analyzed by two blinded cardiologists quantitatively for ST-segment values and qualitatively for an overall ischemia rating. MEASUREMENTS AND MAIN RESULTS: The ST-segment values directly measured by the cardiologists on the simultaneous 12-lead ECGs and those recorded by the monitor during ischemic episodes were found to be clinically comparable (bias, 0.1 mm for both leads; precision, 0.5 mm lead II, 0.9 mm lead V5). The sensitivity of the monitor compared with 12-lead ECGs for the detection of POMI was 73%. Ninety-eight episodes of significant ST deviation were identified in 39 patients. The characteristics of the ischemia detected in this study were similar to those reported in other studies performed using continuous Holter-type monitoring. CONCLUSION: Bedside monitoring of the ST segment in leads II and V5 using Hewlett-Packard Merlin monitors after CABG surgery is as accurate for the measurement of ST deviation in those leads as the clinical gold standard of a 12-lead ECG read by an experienced cardiologist. However, the 12-lead ECG will detect POMI more reliably than an automated two-lead bedside ST-segment analyzer because it allows evaluation of more leads and of ST-segment and T-wave morphology. Bedside ST-segment monitoring in this study confirmed the high incidence of ischemia after CABG surgery shown previously using Holter monitoring.

Adult↗
PubMed1986

Detection of thiopentone-reactive IgE antibodies following anaphylactoid reactions during anaesthesia.

A radioimmunoassay was developed to detect IgE antibodies to the anaesthetic induction agent thiopentone. Significant levels of thiopentone-reactive IgE antibodies were found in the sera of two patients who had experienced life-threatening anaphylactoid reactions following administration of the drug. Inhibition experiments revealed that cross-reactivity occurs between the drug-reactive IgE antibodies and four barbiturate analogues pentobarbitone, phenobarbitone, barbitone and methohexital. The assay should supplement skin testing for the detection of patients with potentially lethal sensitivity to thiopentone.

Anaphylaxis↗