Articles from Anaesthesia 2009 April

Anaesthesia · Apr 2009

Effects of reverse Trendelenburg position and inguinal compression on femoral vein cross-sectional area in infants and young children.

This study evaluated the effects of the reverse Trendelenburg position and additional inguinal compression on the cross-sectional area of the femoral vein in paediatric patients. Seventy subjects were allocated to two groups: the infants group and the children group. ⋯ In the infants group, femoral vein cross-sectional area increased by a mean (SD) of 21.1 (15.2) % in the reverse Trendelenburg position and by 60.7 (30.8) % in the reverse Trendelenburg position with inguinal compression; whereas in the children group, femoral vein cross-sectional area increased by 24.7 (15.8) % in the reverse Trendelenburg position and by 100.3 (50.7) % in the reverse Trendelenburg position with inguinal compression. Inguinal compression in the reverse Trendelenburg position offers a useful means of increasing femoral vein cross-sectional area in paediatric patients.

Mortality related to anaesthesia in France: analysis of deaths related to airway complications.

Death certificates from the French national mortality database for the calendar year 1999 were reviewed to analyse cases in which airway complications had contributed to peri-operative death. Respiratory deaths (and comas) found in a previous national 1978-82 French survey (1:7960; 95% CI 1:12,700 to 1:5400) were compared with the death rate found in the present one: 1:48,200 (95% CI 1:140,000 to 1:27,500). ⋯ In most cases, there were both inadequate practice and systems failure (inappropriate communication between staff, inadequate supervision, poor organisation). This large French survey shows that deaths associated with respiratory complications during anaesthesia have been strikingly reduced during this 15-year period.

Comparison of central venous oxygen saturation and mixed venous oxygen saturation during liver transplantation.

Central venous catheterisation is commonly performed during major surgery and intensive care, and it would be useful if central venous oxygen saturation could function as a surrogate for mixed venous oxygen saturation. We studied 50 patients undergoing living related liver transplantation. Blood samples were taken simultaneously from central venous and pulmonary artery catheters at nine time points during the pre-anhepatic, anhepatic, and postanhepatic phases. ⋯ The mean (SD) difference (95% limit of agreement) was lowest at the first time point (1.06 (0.65)%, -1.94% to 2.7%) and then increased throughout the study but remained acceptable. The change in mixed venous oxygen and central venous oxygen saturations occurred mostly in parallel and as a result changes in mixed venous oxygen saturation were reflected adequately in the change in central venous oxygen saturation. The correlation between mixed venous oxygen saturation and cardiac output was poor.