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A 44-year-old pregnant female with a gestation of 29 weeks suddenly developed abdominal pain, nausea, vomiting, and laboratory study showed anemia, elevated liver enzymes, and lower platelets. HELLP syndrome was diagnosed and urgent delivery was needed. In order to correct the plasma volume and platelet deficiency, 6 units of both fresh frozen plasma and platelets, were given before operation. However, acute pulmonary edema was noted in the antepartum period. After vigorous treatment, she gave birth to a male infant. The postoperative course was smooth and she and her baby were discharged eleven days later. This case reminded us once again of the importance and necessity of invasive monitoring in fluid management of these patients.

Background: Patients who receive cardiac procedures, in particular "redo" ones, often suffer complications from massive bleeding, largely due to bypass-induced coagulopathies. Cardiopulmonary bypass (CPB) may cause damage of the blood components, both in terms of quality and quantity. In order to investigate the qualitative changes of blood constituents with special regard to coagulation resulting from the complex insult of previous cardiac surgery, thromboelastography (TEG) was used to analyze the whole clotting process., Methods: Seventy-four patients who underwent cardiac surgery with CPB were prospectively studied. Of them, 32 patients received "redo" cardiac surgery. Blood samples for routine laboratory coagulation tests (RCT) and TEG examination were drawn before and after cardiopulmonary bypass. Clinically significant bleeding was defined if the chest tube drainage was greater than 100 ml/h for 3 consecutive h or greater than 300 ml in 1 h during the first 8 h after surgery. Prebypass and postbypass coagulation parameters were compared and the percentage of accuracy, false positive and false negative rate were deduced from calculation., Results: In the TEG tracings, preoperative alpha angle and maximum amplitude were significantly decreased in the "redo" group when compared with primary group, indicating less competent platelet function and platelet-fibrin interaction. Lower platelet count was also found by conventional coagulation tests in "redo" patients. Postoperatively, higher percentage of excessive hemorrhage was also noted in the "redo" group (42.8% vs. 27.5% in primary group). However, a much lower predictive accuracy was found in "redo" patients in comparison with primary cardiac patients (53.5% vs. 90%)., Conclusions: We concluded that thromboelastography failed to predict postoperative hemorrhage in "redo" cardiac patients and the graphic recordings derived could not be treated as a guide of transfusion therapy. We thought that inferior preoperative hemostatic status and severer coagulopathy might be responsible for the differences between "redo" and primary cardiac patients.

Background: Postoperative nausea together with vomiting (PONV) is a common adverse effect of general anesthesia. Ondansetron, a new serotonin (5-hydroxytryptamine) receptor antagonist of the subtype 3 is shown to be effective and safe in the prophylaxis and treatment of PONV. However, the clinical experiences of using ondansetron for prevention of PONV is lacking in Taiwan. The purpose of this study is to evaluate the efficacy and safety of ondansetron for prevention of PONV in Chinese children., Methods: Eighty pediatric patients aged from 2 to 12 years undergoing herinorrhaphy were prospectively randomized to receive either ondansetron 0.1 mg/kg or saline placebo. All patients received general anesthesia with tracheal intubation. The parents of patients were educated how to record the episodes of postoperative emesis and other complications and answer questions in the form of questionnaire. The observation period lasted for 24 h postoperatively., Results: The incidence of postoperative emesis was 55% and 10% in placebo and ondansetron group respectively. As to the severity of emetic symptoms it was milder in the ondansetron group. There was no difference in the incidence of other complications between the two groups., Conclusions: The intravenous administration of ondansetron 0.1 mg/kg is safe and effective in reducing postoperative emesis in Chinese children undergoing herinorrhaphy surgery.

Background: Severe hemorrhagic tendency often complicates cardiopulmonary bypass (CPB) in cardiac surgery. In this study, we compared the effectiveness of thromboelastography (TEG), Sonoclot (SCT), and routine coagulation test (RCT) in the prediction of coagulation defects., Methods: Forty-three patients undergoing cardiac surgery with CPB were included. Blood for RCT, TEG, and SCT profiles was sampled before systemic heparinization and after protamine administration. Clinically significant bleeding was defined as chest tube drainage in excess of 100 ml/h for 3 consecutive hours or 300 ml/h in 1 h. All coagulation parameters obtained before and after CPB were compared. The sensitivity, specificity, accuracy, false positive, and false negative rate were also calculated and compared., Results: All coagulation tests were within normal range except higher partial thromboplastin time. Variables which were significantly different from those before CPB included platelet count, fibrinogen level, prothrombin time, and thrombin time in RCT, alpha angle and maximum amplitude in TEG, and R2 and peak time in SCT. In the TEG tracing, all variables had high sensitivity, specificity, and accuracy (average 85.4%, 83%, and 83.5% respectively) and low false positive and negative rate (12.5% and 5% respectively). Although SCT had high sensitivity (76.3%) and low false negative rate (6.5%), its specificity and accuracy were all under 50%., Conclusions: Our data demonstrated that the TEG monitoring is a useful tool for detecting post-CPB bleeding diathesis and can provide much predictive information. RCT and SCT are of limited value because of higher rate of unreliable results.

In order to investigate the possible antiemetic property of propofol at subhypnotic dosage, fifty patients scheduled for elective cesarean section under spinal anesthesia were accepted into the study. Patients were randomly given intravenous propofol 10 mg (group I) or 1 ml intralipid (group II) after delivery of the infant. Overall incidence of nausea (24% in group I and 40% in group II) and vomiting (16% in group I and 20% in group II) were not statistically different in the two groups. However, onset time to the appearance of nausea and vomiting were longer in group I (14 +/- 5.8 min vs 5.4 +/- 3.6 min). In conclusion, low dose propofol (10 mg) administered during spinal anesthesia for cesarean section failed to reduce the incidence of emesis.