Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Perioperative stroke is associated with significant morbidity and mortality yet patients may not be aware of their risk or receive appropriate counselling. Our objectives were to 1) compare patient's perceived vs calculated risk of stroke; 2) determine level of worry; and 3) assess prior discussion about perioperative stroke risk amongst elective patients undergoing non-cardiac, non-neurologic surgery. ⋯ Patients at higher risk of stroke frequently underestimate their risk of perioperative stroke. The majority of patients had not discussed perioperative stroke prior to anesthetic consultation.
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Patients with cirrhosis and concomitant coronary/valvular heart disease present a clinical dilemma. The therapeutic outcome of major cardiac surgery is significantly poorer in patients with cirrhosis compared with patients without cirrhosis. To address this, we aimed to identify associations between the severity of cirrhosis and post-cardiac surgical outcomes. ⋯ Despite having low median model for end-stage liver disease scores, this small series of cirrhotic patients undergoing cardiac surgery had significantly higher mortality rates and required more organ support postoperatively than propensity score-matched non-cirrhotic patients. Impact de la cirrhose chez les patients subissant une chirurgie cardiaque : une étude de cohorte observationnelle et rétrospective.
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Randomized Controlled Trial
The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial.
Despite the uncertain effects of anxiolytic premedication with benzodiazepines on the quality of postoperative recovery, perioperative benzodiazepine administration is still a common practice in many hospitals. We evaluated the effect of premedication with midazolam on the quality of recovery in hospitalized patients undergoing a laparotomy. ⋯ Administration of midazolam as premedication for laparotomy patients did not improve the quality of recovery up to one week after surgery. General prescription of midazolam as premedication can be questioned and might only suit some patients.
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Observational Study
Risk factors for reintubation after anterior cervical discectomy and fusion surgery: evaluation of three observational data sets.
Postoperative loss of airway requiring reintubation is a rare but potentially catastrophic complication following anterior cervical discectomy and fusion (ACDF). We sought to identify risk factors asscociated with reintubation within one day following ACDF. Attention was focused on patient demographics, comorbidities, and factors potentially linked to soft tissue swelling and hematoma formation that could compromise the upper airway. ⋯ Across three complementary data sets, incidence of reintubation within one day of ACDF was approximately 0.20%. Increased risk of reintubation associated with anticoagulant administration suggests upper airway hematoma as an underlying etiology. Steroid administration and delayed extubation may be useful in patients considered to be at higher risk for reintubation.