British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation.
Hydroxyethyl starch (HES) may affect blood coagulation. We studied the effects of a modified, balanced, high-molecular weight [mean molecular weight (MW) 550 kDa], high-substituted [degree of substitution (DS) 0.7] HES preparation (Hextend) on coagulation in patients undergoing major abdominal surgery. ⋯ A modified, balanced high-molecular weight HES with a high degree of substitution (Hextend) adversely affected measures of coagulation in patients undergoing major abdominal surgery, whereas a preparation with a low MW and low DS affected these measures of haemostasis less. Large amounts of RL decreased the coagulation time.
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Randomized Controlled Trial Comparative Study Clinical Trial
The laryngeal tube compared with the laryngeal mask: insertion, gas leak pressure and gastric insufflation.
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Residual paralysis following the use of neuromuscular blocking drugs remains a clinical problem. As part of departmental quality assurance, we examined the degree of postoperative residual curarization (PORC) following atracurium. ⋯ PORC remains a clinical problem despite use of intermediate-duration neuromuscular blocking drugs and peripheral nerve stimulators. Patients undergoing procedures of short duration may be at risk of inappropriately early tracheal extubation, possibly due to work pressures. The association between suboptimal antagonism of neuromuscular blockade and short procedures needs reinforcement during postgraduate training and departmental quality assurance.
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The increasing number of patients with coronary artery disease undergoing major non-cardiac surgery justifies guidelines concerning preoperative evaluation, stress testing, coronary angiography, and revascularization. A review of the recent literature shows that stress testing should be limited to patients with suspicion of a myocardium at risk of ischaemia, and coronary angiography to situations where revascularization can improve long-term survival. Recent data have shown that any event in the coronary circulation, be it new ischaemia, infarction, or revascularization, induces a high-risk period of 6 weeks, and an intermediate-risk period of 3 months. ⋯ However, this delay may be too long if an urgent surgical procedure is requested, as for instance with rapidly spreading tumours, impending aneurysm rupture, infections requiring drainage, or bone fractures. It is then appropriate to use perioperative beta-block, which reduces the cardiac complication rate in patients with, or at risk of, coronary artery disease. The objective of this review is to offer a comprehensive algorithm to help clinicians in the preoperative assessment of patients undergoing non-cardiac surgery.
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We present three cases of epidural abscess, all in patients in whom an epidural catheter had been inserted for postoperative pain management. In all three cases the infecting organism was Staphylococcus aureus and two patients had diabetes. ⋯ We have retrospectively calculated the incidence of epidural abscess in our hospital over the 5-yr period 1993-98 to be 1 in 800 (0.12%). We emphasize the importance of using techniques that minimize the risk of bacterial contamination during both catheter placement and the management of infusion, and seek to raise awareness of this relatively rare but significant condition.