Anaesthesia
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Mortality after lower limb amputation is high, with UK 30-day mortality rates of 9-17%. We performed a retrospective analysis of factors affecting early and late outcome after lower limb amputation for peripheral vascular disease or diabetic complications at a UK tertiary referral vascular centre between 2003 and 2010. Three hundred and thirty-nine patients (233 male), of median (IQR [range]) age 73 (62-79 [26-92]) years underwent amputation. ⋯ Anaesthetic technique was associated with long-term mortality on survival analysis (p = 0.04), but not when analysed using regression modelling. Mortality after lower limb amputation relates to patient age, ASA, out-of-hours surgery and renal dysfunction. These data support lower limb amputations' being performed during daytime hours and after modification replace with 'of ' correctable risk factors.
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Randomized Controlled Trial
Effects of ropivacaine concentration on the spread of sensory block produced by continuous thoracic paravertebral block: a prospective, randomised, controlled, double-blind study.
Factors affecting the distribution of continuous thoracic paravertebral block have never been examined. We designed this prospective, double-blind study to check whether continuous thoracic paravertebral block with a higher ropivacaine concentration would provide a wider segmental sensory block spread. Sixty consecutive patients undergoing pulmonary lobectomy or segmentectomy were randomly allocated to receive continuous paravertebral infusion of either 0.2% or 0.5% ropivacaine (6 ml.h(-1) ). ⋯ Twenty-seven patients per group were included in the final analysis. The median (IQR [range]) number of anaesthetised dermatomes 24 h after surgery was 4 (3-6 [1-9]) with ropivacaine 0.2% and 4 (3-6 [2-11]) with ropivacaine 0.5% (p = 0.66). Contrary to our expectation, the segmental spread of sensory block produced by continuous thoracic paravertebral block does not depend on ropivacaine concentration.
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The bougie is a popular tool in difficult intubations. The hold-up sign is used to confirm tracheal placement of a bougie. This study aimed to establish the potential for airway trauma when using this sign with an Eschmann re-usable bougie or a Frova single-use bougie. ⋯ It is possible to apply a force at least five times greater than the force required to produce significant trauma with a Frova single-use bougie. We recommend that the hold-up sign should no longer be used with single-use bougies. Clinicians should be cautious when eliciting this sign using the Eschmann re-usable bougie.
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We compared the force of extraction for peripheral nerve catheters under three different situations in a porcine model using untunnelled, tunnelled and double-tunnelled catheters. Following insertion of the catheter into the porcine model, the catheters were either left untunnelled or a single or double tunnel was created for the catheter. ⋯ Tunnelling a peripheral nerve catheter leads to a significant increase in the force required for dislodgement. This is increased further by introducing a second tunnel.