Anaesthesia
-
High-risk surgery is performed in every acute hospital. These patients often have increased peri-operative risk related to their poor cardiorespiratory reserve. Formal risk assessment is recommended for such patients; cardiopulmonary exercise testing is a well established triage tool, but is unavailable in many hospitals. ⋯ A cut-off distance of 250 m had a specificity of 0.88 and a sensitivity of 0.58 to predict postoperative complications. Patients unable to complete a shuttle walk test above this cut-off distance were three times more likely to have a postoperative morbidity. We conclude that the shuttle walk test can help identify patients who are at increased peri-operative risk.
-
Cuff-occluded rate of rise of peripheral venous pressure has been proposed to reflect volume changes in experimental studies. The aim of this study was to evaluate changes in cuff-occluded rate of rise of peripheral venous pressure associated with fluid removal by haemodialysis in six adult patients with chronic renal failure on intermittent haemodialysis. ⋯ The volume of fluid removed (indexed to body surface area) linearly correlated with changes in cuff-occluded rate of rise of peripheral venous pressure (r = 0.84; r(2) = 0.70; p = 0.037). Cuff-occluded rate of rise of peripheral venous pressure may be feasible for future clinical monitoring of individual fluid balance.
-
We analysed more than 7000 theatre lists from two similar UK hospitals, to assess whether start times and finish times were correlated. We also analysed gap times (the time between patients when no anaesthesia or surgery occurs), to see whether these affected theatre efficiency. Operating list start and finish times were poorly correlated at both hospitals (r(2) = 0.077 and 0.043), and cancellation rates did not increase with late starts (remaining within 2% and 10% respectively at the two hospitals). ⋯ Lists with no gaps still exhibited extremely variable finish times and efficiency. We conclude that resources expended in trying to achieve prompt start times in isolation, or in reducing gap times to under ~15% of scheduled list time, will not improve theatre productivity. Instead, the primary focus should be towards quantitative improvements in list scheduling.