[HSF] More Bad News About Trasylol

[Hgrmd at aol.com]

Michael,
  I hear you.  There is no perfect solution.  My intent is  to take the path 
least likely to produce litigation as well as to give the best  result.   As 
far as I know, Amikar is not associated with ATN.   Many years ago, I used Pat 
Daley's protocol which was to give 10 grams on  induction, 10 grams after 
heparization, and 10 grams after protamine.   Using that protocol, I swear I 
didn't have a single bring back for over 9  months.  However, I remember using it 
on a frail little lady with crappy  targets.  While I was closing, the ST's 
shot up; the vein grafts were all  clotted.  I crashed back on, but she 
eventually died from the low output  associated with a huge, global infarct.  After 
that, I cut back on the  amount, but I still use it on practically every case.  I 
don't know how  much it helps, since I admittedly have my share of bring 
backs.  The key to  managing postop bleeding is recognizing early signs of 
tamponade, and going back  before the patient falls apart.  With that approach, I 
don't think a bring  back has to add that much morbidity.  BTW, both of those 
cases from  yesterday are extubated and doing fine.
Hal