Gastric POCUS, 3-Part Episode
April 2024 OA-POCUS Case of the Month
Anesthesia Services in Tanzania and Kenya
OA-Global Health Equity Ask the Experts - April 2024
REPOST: October 2021 – Pediatric Tracheal Extubations
April 2024 OA-SPA Ask the Expert
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Question of the Day
A 13-year-old girl with severe idiopathic scoliosis presents for Harrington rod placement. She is administered bolus of 100 mg/kg tranexamic acid followed by an infusion. For which of the following postoperative complications is her risk MOST increased as a result of the administration of tranexamic acid?
Explanation
Antifibrinolytic medications may be given to patients undergoing major scoliosis repair in order to decrease bleeding and risk of a blood transfusion. Tranexamic acid is a lysine analog that prevents fibrinolysis by binding to the lysine binding site on plasminogen and competitively inhibiting the conversion of plasminogen to plasmin. Thus, there is less plasmin for the degradation of fibrin. Administration of tranexamic acid in total doses greater than 80-100 mg/kg may be associated with seizure activity. The mechanism by which tranexamic acid acts as a proconvulsant involves a dose-dependent gamma-aminobutyric acid receptor (GABA) antagonism. Several studies have demonstrated an increased incidence of postoperative seizures in patients receiving high doses of tranexamic acid.
References:
Martin K, Knorr J, Breuer T, et al. Seizures after open heart surgery: comparison of ε-aminocaproic acid and tranexamic acid. J Cardiothorac Vasc Anesth. 2011;25(1):20-25. doi:10.1053/j.jvca.2010.10.007 Sharma V, Katznelson R, Jerath A, et al. The association between tranexamic acid and convulsive seizures after cardiac surgery: a multivariate analysis in 11 529 patients. Anaesthesia. 2014;69(2):124-130. doi:10.1111/anae.12516 AntifibrinolyticsOA Series:
06:08
OA-POCUS Case of the Month
Gastric POCUS, Part 1 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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17:46
OA-POCUS Case of the Month
Gastric POCUS, Part 2 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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04:43
OA-POCUS Case of the Month
Gastric POCUS, Part 3 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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41:04
OA Global Health Equity Ask the Expert
Anesthesia Services in Tanzania and KenyaSamuel Percy, MD, Children's Hospital Colorado
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16:40
OA-SPA Ask the Expert
REPOST: October 2021 – Pediatric Tracheal ExtubationsDebnath Chatterjee, MD, FAAP, Children’s Hospital Colorado, Aurora, CO
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