Heparin Associated Thrombocytopenia

Due to a lack of standard diagnostic criteria and lab tests, the incidence of HAT has been variably reported in the literature (1.1-30 ). More recent estimates puts the incidence at 3.0 . HAT is increased with prior exposure to heparin and the type of heparin. Platelet Factor 4 (PF4) is a heparin binding protein stored in platelets and released into plasma following platelet activation. Heparin PF4 complexes normally do not have adverse sequelae. Specific antibodies to Heparin PF4 complexes...

Postoperative Hypertension

Consider the following four factors in the management of hypertension etiology, LV function, renal function, age. In most cases, restart the preoperative antihypertensive medications unless there have been postoperative changes in LV and or renal function. Table 40.2 summarizes current treatment of patients with postoperative hypertension at TGH. All postoperative patients with a Type A or B dissection, take beta-blockers, regardless of age, unless otherwise contraindicated. Carefully evaluate...

Renal Insufficiency

Patients with renal dysfunction present particular challenges to the anesthesiologist during cardiopulmonary bypass (CPB) surgery. The incidence of perioperative renal dysfunction is 7.7 , whereas oliguria renal failure occurs in 1.4 of CPB patients. End stage renal disease from various etiologies itself causes multi-system effects including hypertension, anemia, abnormal coagulation and alterations in intravascular volume, electrolytes and acid-base status. Table 9.1. Complications of Diabetes...

Alternatives To Heparin For

Low Molecular Weight Heparins (LMWHS) A new class of anticoagulants widely used in Europe with few approved in North America. They are fragments of heparin produced by chemical or enzymatic depolymerization of standard heparin. Unlike standard heparin, LMWHs are unable to bind thrombin (Ila) and anti-thrombin III (ATIII) simultaneously so they cannot accelerate the inactivation of Ila, but do inhibit Xa activity. The anti-Xa anti-IIa ratio of LMWHs ranges from 2 1-4 1 and are based on in vitro...

Metabolic

Patients are often seen by the endocrine service preoperatively and already have a sliding insulin scale written (Table 32.5). Patients on multiple inotropes may need a more generous insulin dose. Only 2 of total body K+ is extracellular (70 meq of 3500 meq total lean body weight) and measured by serum levels (normal serum K+ 2 - 4 meq L). There is a nonlinear relationship between total body K+ and serum K+ (Table 32.6). Depletion causes less change in serum K+ due to intracellular Table 32.5....