Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2014
Evaluation of differences in patient and physician perception of benefit and risks of aspirin and antifibrinolytic therapy in cardiac surgery.
It is unclear whether physicians and patients have similar concerns and preferences when considering benefit and risks of aspirin and antifibrinolytic therapy for cardiac surgery. We surveyed both groups to ascertain their perceptions and preferences for treatment in this setting. Both preoperative and postoperative cardiac surgical patients and the physician craft groups caring for them (cardiology, surgery, anaesthesia/critical care), were provided with estimates of benefits and risks of aspirin and antifibrinolytic therapy. ⋯ For antifibrinolytic therapy, the tolerated increased relative risk of stroke for physicians was 20% versus patients 10% (P=0.004), and for myocardial infarction, physicians 16.7% versus patients 4.2% (P <0.001). The three physician craft groups had comparable tolerances of thrombotic risk. Patient and physician preferences for perioperative aspirin and antifibrinolytic therapy sometimes differ based on risk benefit analysis.
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Anaesth Intensive Care · Sep 2014
Anaesthesia-related haemodynamic complications in Williams syndrome patients: A review of one institution's experience.
Williams syndrome is a genetic disorder associated with cardiac pathology, including supravalvular aortic stenosis and coronary artery stenosis. Sudden cardiac death has been reported in the perioperative period and attributed to cardiovascular pathology. In this retrospective audit, case note and anaesthetic records were reviewed for all confirmed Williams syndrome patients who had received an anaesthetic in our institution between July 1974 and November 2009. ⋯ Twelve of the anaesthetics (11.1%) were associated with cardiac complications including cardiac arrest in two cases (1.85%). Of the two cardiac arrests, one patient died within the first 24 hours postanaesthetic and the other patient survived, giving an overall mortality of 0.9% (3.4%). We conclude that Williams syndrome confers a significant anaesthetic risk, which should be recognised and considered by clinicians planning procedures requiring general anaesthesia.
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Anaesth Intensive Care · Sep 2014
Predicting patients at risk of early postoperative adverse events.
Adverse events after surgery are common. Identification of markers of at-risk patients may facilitate efficient and effective perioperative resource allocation. This pilot study aimed to identify simple preoperative factors associated with postoperative adverse events. ⋯ Areas under receiver operating characteristic curves ranged from 0.63 to 0.80. Patients with adverse events in the post-anaesthesia care unit appeared to have a higher risk of intervention in postoperative wards from a medical emergency or intensive care unit team. Our preliminary findings suggest that preoperative identification of key factors may have utility in determining risk of early postoperative problems and hence, aid perioperative planning.
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Anaesth Intensive Care · Sep 2014
Adequate images in intraoperative transoesophageal echocardiography: a quality improvement project.
A suggested standard examination (SSE) for intraoperative transoesophageal echocardiography for cardiac surgery was developed at the Green Lane Department of Cardiothoracic and Otorhinolaryngology Anaesthesia at the Auckland City Hospital. The examination includes views to be recorded in all patients pre- and post-cardiopulmonary bypass. ⋯ A baseline mean acquisition ratio of 0.62 was achieved, which was not significantly changed by the introduction of the SSE. Nevertheless, we found the SSE to be a useful audit tool and believe it might be of interest to others to assist with perioperative transoesophageal echocardiography quality assurance and education.
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Anaesth Intensive Care · Sep 2014
Lateral cutaneous femoral nerve blockade-limited skin incision coverage in hip arthroplasty.
This paper seeks to assess the potential use of blocking the lateral cutaneous femoral nerve (LCN) for patients undergoing hip surgery. In this study, ultrasound guidance was used to specifically block the LCN using a small volume of local anaesthetic in 20 healthy volunteer anaesthetists. An orthopaedic surgeon then drew lines on the volunteers reflecting three common cutaneous incision lines (anterolateral, lateral, and posterior approach) for hip arthroplasty using an ultraviolet reflecting pen invisible in normal lighting. ⋯ Of the remaining incision lines drawn, most were less than half covered by LCN blockade with only three lines more than 50% covered and none more than 75% covered. The skin anaesthesia produced by LCN blockade was usually anterior and inferior to the surgical lines marked. This significant lack of overlap between common hip arthroplasty incision lines and the anaesthesia produced by blockade of the lateral cutaneous femoral nerve draws into question the utility of this block for hip surgery.