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Anaesthesia, 2003, 58, pages 617–622
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Correspondence
The Duxford Aviation Society may
be grateful for the hits, but not the
anaesthetists who go there.
Also, the DAS website either does
not contain the ‘‘Airway Alert’’ docu-
ment mentioned in the article, or it is so
well hidden……
I hope this may be of use to others.
A major problem faced by anaesthet-
ists is the monitoring of the effects of
antiplatelet medication. Although the
platelet function analyser (PFA-100,
Dade Behring, IL, USA) appears to be
the answer to this problem, it is a global
test of primary haemostasis and is not
specific for antiplatelet drugs [1]. The
PFA-100 has been used to monitor the
antiplatelet effect of aspirin [2]; how-
ever, the results may be affected by the
citrate concentration in the sampling
tube [3]. There is less experience with
the use of the PFA-100 to assess the
effect of clopidogrel, and it is uncertain
whether the citrate concentration is also
important in this situation.
E. Melillo
Clifford Bridge Road,
Coventry CV2 2DX,
UK
E-mail: edwardmelillo@yahoo.com
J. Davies
Predicting difficult intubation;
useful or what? A response to
‘Predicting difficult intubation –
worthwhile exercise or
pointless ritual?’, Anaesthesia
2002; 57: 105–109.
Royal Lancaster Infirmary,
Lancaster LA1 4RP, UK
E-mail: john.davies@wgh.mbht.nhs.uk
A response to the on-line
correspondence from
Davies JR, above.
Even though the editorial ‘Predicting
difficult intubation – worthwhile exer-
cise or pointless ritual?’ raises doubts
about the value of tests of airway
assessment, the actual exercise is some-
times quite helpful in providing useful
clinical information.
A 92-year-old lady presented on the
trauma list for a dynamic hip screw
fixation of a fractured neck of femur.
On examination, it was noted that she
had atrial fibrillation, rate of 120 bpm
despite having been given an additional
dose of digoxin. The trainee anaesthetist
performed a routine airway assessment
to find that this pleasantly confused lady
had kept both her tablets safely in her
mouth between her gums and teeth
which she then generously proceeded
to offer to the anaesthetist. The heart
rate was subsequently controlled by
making sure she swallowed her tablets.
So the test was worthwhile after all,
though for an entirely different reason!
Results from the PFA-100 may also
be affected by smoking, haematocrit
and gender [1].
Dr Davies is quite right about the URL
error.
Currently two URLs will get you
to the Difficult Airway Society. These
The Thrombelastographꢀ (TEGꢀ)
Haemostasis Analyser (Haemoscope
Corp., USA) is a near-patient method
of monitoring whole blood coagulation.
Standard use of the TEGꢀ system
cannot detect the effect of aspirin [4].
However, a new TEGꢀ assay has been
developed specifically for this purpose
(Personal Communication: Haemo-
scope Corp., USA).
The use of antiplatelet medication has
implications for the safety of regional
anaesthesia and propensity to bleed
during surgery. Further studies are nee-
ded to provide a sufficiently robust
method of platelet function assessment
to guide anaesthetic management.
are
and
I’ve contacted the editor of Anaesthe-
sia and the DAS ‘webmaster’ about this
last month.
The ‘Airway Alert’ has not been put
into the DAS website yet, it may be
incorporated into the existing Difficult
Airway database. I’ve referred this issue
to the officers of the DAS.
Thank you for raising these matters…
communication is crucial.
D. Ball
Dumfries and Galloway Royal
Infirmary,
Bankend Road,
R. Self
Dumfries, UK
Royal Free Hospital,
Pond Street,
E-mail: d.ball@dgri.nhs.scot.uk
R. Sundaram
Victoria Infirmary,
London NW3 2QG, UK
E-mail: reself@doctors.org.uk
12 Woodland Crescent,
Eaglesham, Glasgow G76 0ND, UK
E-mail: sundaramradha@hotmail.com
A response to ‘Remifentanil
infusion rate calculation’,
Chelliah S, Anaesthesia
2003; 58: 104.
References
1 Favaloro E. Clinical applications of the.
PFA-100;Current Opinion in Hematology
2002; 9: 407–15.
A response to ‘The
I find the following method of admin- thienopyridine derivatives
istering remifentanil in the absence of a (platelet adenosine
‘clever’ pump quite simple.
2 Homoncik M, Jilma B, Hergovich N
et al. Monitoring of aspirin (ASA)
pharmacodynamics with the Platelet
Function Analyzer PFA-100. Thrombo-
sis and Hemotasis 2000; 83: 316–21.
3 Von Pape K, Aland E, Bohner J.
Platelet Function Analysis with
PFA-100 in patients medicated with
acetylsalicylic acid strongly depends
diphosphate receptor
By diluting remifentanil to 60 lg.ml antagonists), pharmacology
(i.e. 1 mg in 17 ml, 2 mg in 33 ml or, and clinical developments’,
more commonly, 3 mg in 50 ml), Kam PCA, Nethery CM,
1 ml.kg)1 h)1 equates to 1 lg.kg.min)1
.
Anaesthesia 2003; 58: 28–35.
Thus for a 70-kg patient, 70 ml.h ¼
1 lg.kg.min)1 and 7 ml.h ¼ 0.1 lg.kg.
We read with interest the recent review
min)1; 14 ml.h ¼ 0.2 lg.kg.min)1, etc. about thienopyridine antiplatelet drugs.
Ó 2003 Blackwell Publishing Ltd
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