British journal of anaesthesia
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Clinical Trial
ASA classification and perioperative variables as predictors of postoperative outcome.
In a prospective study of 6301 surgical patients in a university hospital, we examined the strength of association between ASA physical status classification and perioperative risk factors, and postoperative outcome, using both univariate analysis and calculation of the odds ratio of the risk of developing a postoperative complication by means of a logistic regression model. Univariate analysis showed a significant correlation (P < 0.05) between ASA class and perioperative variables (intraoperative blood loss, duration of postoperative ventilation and duration of intensive care stay), postoperative complications and mortality rate. ⋯ Estimating the increased risk odds ratio for single variables, we found that the risk of complication was influenced mainly by ASA class IV (risk odds ratio = 4.2) and ASA class III (risk odds ratio = 2.2). We conclude that ASA physical status classification was a predictor of postoperative outcome.
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We have measured platelet count, bleeding time and thrombelastography (TEG) variables and the correlation between these variables in 49 pregnant patients presenting with pre-eclampsia or eclampsia. Eighteen patients (37%) had a platelet count < or = 150 x 10(9) litre-1 and seven (14%) had a platelet count < or = 100 x 10(9) litre-1. Bleeding time was prolonged > 9.5 min in 13 (27%) patients and the TEG was abnormal in four (8%). ⋯ Of the 10 (20%) patients with an adequate platelet count (> 100 x 10(9) litre-1) but prolonged bleeding time, the TEG was normal, suggesting adequate haemostasis. An MA of 53 mm, which is the lower limit for normal pregnancy, correlated with a platelet count of 54 x 10(9) litre-1 (95% confidence limits 40-75 x 10(9) litre-1). Although the number of patients with severe thrombocytopenia was small, a platelet count of 75 x 10(9) litre-1 should be associated with adequate haemostasis.
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Cardiac arrest occurred on arrival in the recovery room after emergency Caesarean section under subarachnoid block. The patient was resuscitated successfully and recovered with no adverse effects. The current literature is reviewed and the pathophysiological mechanisms involved in the aetiology of cardiac arrest under subarachnoid block are discussed. Early use of adrenaline to treat severe bradycardia or hypotension is recommended.
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Volume loading with crystalloid solution results in more pronounced haemodilution in patients who develop arterial hypotension during induction of extradural anaesthesia than in those who remain normotensive. The aim of this study was to describe the time course of this increase in haemodilution. Heart rate, systolic arterial pressure and blood haemoglobin concentration were measured every 3 min during the onset of extradural anaesthesia in 22 elderly men undergoing short urological operations. ⋯ Patients with a decrease in systolic pressure of > 25% retained 50% (SD 12%) of the infused fluid in the circulation, while the others retained 36 (8%) (P < 0.002). In both groups, arterial hypotension was followed by increased haemodilution after a delay of as much as 15 min. This suggests that, despite volume loading, there is relative hypovolaemia throughout the development of hypotension.