European journal of anaesthesiology
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The large majority of patients undergoing ophthalmic surgery are elderly and take systemic medications on a regular basis, including antiplatelet and anticoagulant treatments. It is current practice for many physicians to discontinue antithrombotic treatment prior to surgery to reduce bleeding complications that may lead to retrobulbar haemorrhage and, ultimately, to loss of vision. However, discontinuation of antithrombotic treatment in such patients may lead to thromboembolic events with serious consequences. ⋯ This risk is distinctly higher than the risk of significant local haemorrhage. Ophthalmic bleeding events reported in the literature are usually minor, without serious consequences, even if antiplatelet or anticoagulant treatments are continued, provided that the anticoagulation level is within the therapeutic range. Thus, the current data are in favour of maintaining antiplatelet and anticoagulant drugs for most ophthalmic procedures, regardless of the anaesthetic techniques.
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Comparative Study
A comparison of noninvasive bioreactance with oesophageal Doppler estimation of stroke volume during open abdominal surgery: an observational study.
The anaesthetist must maintain tissue perfusion by ensuring optimal perioperative fluid balance. This can be achieved using less invasive cardiac output monitors such as oesophageal Doppler monitoring (ODM). Other less invasive cardiac output monitors using bio-impedence technology (noninvasive cardiac output monitoring, NICOM) may have a role in monitoring the circulation and informing fluid management decisions. ⋯ Simultaneous stroke volume estimations made by noninvasive Bioreactance (NICOM) and oesophageal Doppler showed bias and limits of agreement that are not clinically acceptable. The measurements made by these two devices cannot be regarded as interchangeable.
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Lung ultrasound imaging can be used to evaluate pulmonary water content and pulmonary consolidation in ICU patients, but data from neurocritical care are lacking. ⋯ In neurocritical care, the use of lung ultrasound allows detection of increased lung water content when more than three 'B-lines' are present within the same lung field. This is associated with a reduction in PaO2/FiO2 ratio. Lung ultrasound can be used to diagnose pulmonary consolidation with an accuracy similar to the chest radiograph.
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Comparative Study
Comparison of three techniques for calculation of the Parkland formula to aid fluid resuscitation in paediatric burns.
Inadequate fluid resuscitation of acute burns may result in hypovolaemic shock. Excessive fluid resuscitation may result in fluid overload. A nomogram which uses the popular Parkland formula and '4-2-1' regime has been recently described to facilitate the calculation of fluid requirements in children during the first 24 h following burn injury. ⋯ The nomogram was the most accurate method of calculating fluid requirements using the Parkland formula, was only slightly slower than the electronic calculator and was deemed the easiest to use. The nomogram is also low cost, robust, and provides a rapid means of detecting and preventing the large errors that we have shown can occur when an electronic device is used as the primary method of resuscitation fluid calculation. We, therefore, suggest that the nomogram is a suitable method for the calculation of the Parkland formula to guide resuscitation and maintenance fluid requirements in the first 24 h of paediatric burns or for cross-checking the results obtained by other means of calculation.