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Informed consent for blood transfusion: A regional hospital survey
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GABAA receptor and a chloride ionosphere. Endogenous benzodiazepines, the existence and function of which are controversial, are briefly introduced.-G. ANDERSON Reprint requests to Dr Goodchild: Monash Medical Centre, Clayton Rd, Melbourne, Victoria 3 168, Australia. Effects of Ketorolac Tromethamine (Toradol) on a Functional Model of Microvascular Thrombosis. Buckley R, Davidson
S, Das S. Br J Plas Surg 46:296, 1993 Ketorolac tromethamine is a potent nonsteroidal antiinflammatory drug that has also been shown to inhibit arachidonic acid-induced platelet aggregation. The purpose of this study was to assess the role of ketorolac as an alternative single agent in the prevention of microvascular thrombosis. A rat model of microvascular thrombosis was used in this experiment. Ketorolac or placebo was given to Sprague Dawley rats in a randomized, double-blinded manner. A crush injury was simulated and an arteriotomy with microvascular repair was performed using the superficial femoral artery. Vascular patency, bleeding times, and platelet aggregation profiles were determined. The results showed patency rates at 20 minutes were significantly higher in the ketorolac group compared with controls, but that at 24 hours all vessels were thrombosed. Bleeding times were significantly higher and platelet aggregation significantly lower in the ketorolac group compared with controls. The authors concluded that ketorolac provides a short-term inhibition of platelet aggregation, but does not alter the coagulation cascade sufficiently to prevent eventual thrombus formation as a single agent. They also concluded that due to the increase in bleeding time and inhibition of platelet aggregation, ketorolac should not be used for pain control in patients for whom postoperative hematoma formation is a concern.-A. BLUHM Reprint requests to Dr Das: Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 392 16. Reconstruction of Residual Alveolo-Palatal Bone Defects in Cleft Patients. Witsenburg B, Remmelink H. J Cranio-
maxillofac Surg 2 1:239, 1993 Autogenous bone grafting to residual alveolo-palatal bony defects in cleft patients is a widely accepted treatment modality. Forty unilateral cleft patients aged 7.4 to 32.7 years were reviewed clinically and radiographically following residual cleft reconstruction. Radiographic findings, increasing surgeon’s experience, age at time of surgery (I 12 or 2 13 years) and anatomic origin of the graft (anterior illiac crest, n=26, vs mandibular symphasis, n=14), were considered. All patients had similar grafting methods, wound closure, and postoperative care. Oronasal communications were closed successfully in 28 of 3 1 patients. No relationship was found between surgeon experience and radiographic success of all procedures. Patients 12 years or younger enjoyed greater radiographic success than their older counterparts (P < .COOl). Though not of statistical significance, mandibular symphased
CURRENT LITERATURE
bone was observed to produce slightly better results than grafts using anterior illiac crestal bone.-J. LANCE Informed Consent for Blood Transfusion: A Regional Hospital Survey. Eisenstaedt RS, Glanz K, Smith DG, et al: Trans-
fusion 33558, 1993 The doctrine of informed consent has emerged as an element of growing importance in medical decision making. Increased awareness of transfusion risks and recognition of alternatives to allogeneic transfusion has changed decision making in transfusion medicine and the importance of patient participation in the process. Ninety-two hospitals in a threestate mid-Atlantic region were surveyed to determine their policy toward obtaining written informed consent for transfusion and to examine the content of written consent documents and the process by which consent is obtained. Of these hospitals, 62% require written informed consent. The smaller hospitals were more likely to require consent. Twentyseven of 48 informed consent forms mentioned complications, but alternatives to allogeneic transfusion were discussed infrequently. The reading level required to comprehend 34 consent forms submitted was grade 14.6, attained by only 23% of the adult US population. Although the majority of respondent institutions require written informed consent, these forms, per se, do not document that the fundamental tenets of informed choice have been applied to the decision to transfuse blood.-J. MICHAEL MCCOY Reprint requests to Dr Eisenstaedt: Department of Medicine, Temple University School of Medicine, Broad and Ontario Sts, Philadelphia, PA 19140. Contact Diode Laser Microvascular Anastomosis.
Lewis WJ,
Uribe A. Laryngoscope 103850, 1993 This report examined the effects of using a low-cost handheld contact diode laser with a 200~pm synthetic sapphire flat tip for microvascular anastomoses. Four groups of six Sprague-Dawley rats were used to perform anastomoses of femoral arteries and veins using either a standard suturing technique or the hand-held contact diode laser. The standard technique consisted of placing eight to 10 10-O nylon sutures in the right femoral artery and 12 to 16 in the vein. The laserassisted technique used three or four 10-O nylon stay sutures placed with the intervening regions receiving tissue welds with the laser. Patency rates were found to be 100% for all 24 anastomoses. Inflammatory and foreign body reactions were significantly less for the laser groups. No evidence of microaneurysm formation was seen in either group. The laser-assisted arterial and venous microanastomoses averaged three and four times faster, respectively, than conventional techniques. The role of fibrinonectin and the substructure of collagen at the healing sites were also evaluated, and showed no significant differences between groups. The proposed mechanism of tissue welding induced by this laser system was discussed.-J.M. WEES Reprint requests to Dr Lewis: Division of Otolaryngology, The Lankenau Hospital and Medical Research Center, 100 Lancaster Ave, West of City Line, Wynnewood, PA 19096.
GABAA receptor and a chloride ionosphere. Endogenous benzodiazepines, the existence and function of which are controversial, are briefly introduced.-G. ANDERSON Reprint requests to Dr Goodchild: Monash Medical Centre, Clayton Rd, Melbourne, Victoria 3 168, Australia. Effects of Ketorolac Tromethamine (Toradol) on a Functional Model of Microvascular Thrombosis. Buckley R, Davidson
S, Das S. Br J Plas Surg 46:296, 1993 Ketorolac tromethamine is a potent nonsteroidal antiinflammatory drug that has also been shown to inhibit arachidonic acid-induced platelet aggregation. The purpose of this study was to assess the role of ketorolac as an alternative single agent in the prevention of microvascular thrombosis. A rat model of microvascular thrombosis was used in this experiment. Ketorolac or placebo was given to Sprague Dawley rats in a randomized, double-blinded manner. A crush injury was simulated and an arteriotomy with microvascular repair was performed using the superficial femoral artery. Vascular patency, bleeding times, and platelet aggregation profiles were determined. The results showed patency rates at 20 minutes were significantly higher in the ketorolac group compared with controls, but that at 24 hours all vessels were thrombosed. Bleeding times were significantly higher and platelet aggregation significantly lower in the ketorolac group compared with controls. The authors concluded that ketorolac provides a short-term inhibition of platelet aggregation, but does not alter the coagulation cascade sufficiently to prevent eventual thrombus formation as a single agent. They also concluded that due to the increase in bleeding time and inhibition of platelet aggregation, ketorolac should not be used for pain control in patients for whom postoperative hematoma formation is a concern.-A. BLUHM Reprint requests to Dr Das: Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 392 16. Reconstruction of Residual Alveolo-Palatal Bone Defects in Cleft Patients. Witsenburg B, Remmelink H. J Cranio-
maxillofac Surg 2 1:239, 1993 Autogenous bone grafting to residual alveolo-palatal bony defects in cleft patients is a widely accepted treatment modality. Forty unilateral cleft patients aged 7.4 to 32.7 years were reviewed clinically and radiographically following residual cleft reconstruction. Radiographic findings, increasing surgeon’s experience, age at time of surgery (I 12 or 2 13 years) and anatomic origin of the graft (anterior illiac crest, n=26, vs mandibular symphasis, n=14), were considered. All patients had similar grafting methods, wound closure, and postoperative care. Oronasal communications were closed successfully in 28 of 3 1 patients. No relationship was found between surgeon experience and radiographic success of all procedures. Patients 12 years or younger enjoyed greater radiographic success than their older counterparts (P < .COOl). Though not of statistical significance, mandibular symphased
CURRENT LITERATURE
bone was observed to produce slightly better results than grafts using anterior illiac crestal bone.-J. LANCE Informed Consent for Blood Transfusion: A Regional Hospital Survey. Eisenstaedt RS, Glanz K, Smith DG, et al: Trans-
fusion 33558, 1993 The doctrine of informed consent has emerged as an element of growing importance in medical decision making. Increased awareness of transfusion risks and recognition of alternatives to allogeneic transfusion has changed decision making in transfusion medicine and the importance of patient participation in the process. Ninety-two hospitals in a threestate mid-Atlantic region were surveyed to determine their policy toward obtaining written informed consent for transfusion and to examine the content of written consent documents and the process by which consent is obtained. Of these hospitals, 62% require written informed consent. The smaller hospitals were more likely to require consent. Twentyseven of 48 informed consent forms mentioned complications, but alternatives to allogeneic transfusion were discussed infrequently. The reading level required to comprehend 34 consent forms submitted was grade 14.6, attained by only 23% of the adult US population. Although the majority of respondent institutions require written informed consent, these forms, per se, do not document that the fundamental tenets of informed choice have been applied to the decision to transfuse blood.-J. MICHAEL MCCOY Reprint requests to Dr Eisenstaedt: Department of Medicine, Temple University School of Medicine, Broad and Ontario Sts, Philadelphia, PA 19140. Contact Diode Laser Microvascular Anastomosis.
Lewis WJ,
Uribe A. Laryngoscope 103850, 1993 This report examined the effects of using a low-cost handheld contact diode laser with a 200~pm synthetic sapphire flat tip for microvascular anastomoses. Four groups of six Sprague-Dawley rats were used to perform anastomoses of femoral arteries and veins using either a standard suturing technique or the hand-held contact diode laser. The standard technique consisted of placing eight to 10 10-O nylon sutures in the right femoral artery and 12 to 16 in the vein. The laserassisted technique used three or four 10-O nylon stay sutures placed with the intervening regions receiving tissue welds with the laser. Patency rates were found to be 100% for all 24 anastomoses. Inflammatory and foreign body reactions were significantly less for the laser groups. No evidence of microaneurysm formation was seen in either group. The laser-assisted arterial and venous microanastomoses averaged three and four times faster, respectively, than conventional techniques. The role of fibrinonectin and the substructure of collagen at the healing sites were also evaluated, and showed no significant differences between groups. The proposed mechanism of tissue welding induced by this laser system was discussed.-J.M. WEES Reprint requests to Dr Lewis: Division of Otolaryngology, The Lankenau Hospital and Medical Research Center, 100 Lancaster Ave, West of City Line, Wynnewood, PA 19096.