Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2019
Observational StudyAssociations between non-anaemic iron deficiency and outcomes following surgery for colorectal cancer: An exploratory study of outcomes relevant to prospective observational studies.
Iron deficiency is common in colorectal cancer. Despite perioperative guidelines advocating for the correction of non-anaemic iron deficiency prior to major surgery, the impact of this pathology on postoperative outcome is unclear. We conducted a single-centre, historical cohort study of 141 elective resections for colorectal cancer. ⋯ A decrease of two days in days alive and out of hospital at postoperative day 90 was seen in the deficient group on univariate analysis (median (IQR) 81 (75-84) versus 83 (78-84), P = 0.25). This reduced to 1.24 days in multivariate adjusted quantile regression analysis ( P = 0.22). Days alive and out of hospital at day 90, postoperative re-admission and postoperative infection may be meaningful outcome measures for future prospective observational work examining non-anaemic iron deficiency in patients undergoing major surgery for colorectal cancer.
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Anaesth Intensive Care · Mar 2019
Observational StudyThe effect of routine preoperative interruption of dabigatran therapy on coagulation parameters and dabigatran plasma levels in a mixed surgical population.
Dabigatran is an oral anticoagulant used for atrial fibrillation and venous thromboembolism. While an effective antibody reversal agent is available, its cost precludes routine use and the mainstay of preoperative management is timely dabigatran interruption. Unlike warfarin, there are no universally accepted protocols for interruption of dabigatran in the preoperative period and there is uncertainty around the interpretation of standard coagulation tests in the presence of dabigatran. ⋯ Of the standard coagulation tests examined, only the thrombin clotting time (TCT) was abnormal for these two patients. Our interruption protocol was associated with safe dabigatran concentrations in most patients on the day of surgery. A minority of patients had dabigatran concentrations above the safe threshold, which were detectable by abnormal TCT results.
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Anaesth Intensive Care · Mar 2019
Parents welcome follow-up using mobile devices: A survey of acceptability at an Australian tertiary paediatric centre.
Follow-up for ongoing management and monitoring of patients is important in clinical practice and research. While common, telephone follow-up is resource intensive and, in our experience, yields low success rates. Electronic communication using mobile devices including smartphones and tablets can provide efficient alternatives - including SMS (text), online forms and mobile apps. ⋯ Promisingly, 93.2% of respondents were happy to receive follow-up SMSs from the hospital and 80.3% were happy to reply to SMS questions. There was less enthusiasm regarding other modalities, with 59.9% happy to use a website and 69.0% happy to use a mobile app. The results support the introduction of electronic communication for follow-up in our paediatric population.
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Anaesth Intensive Care · Mar 2019
Anatomical and ultrasound description of two transmuscular quadratus lumborum block approaches at L2 level and their application in abdominal surgery.
The transmuscular quadratus lumborum (TQL) block is one of the recently evolved myofascial blocks utilised in abdominal surgery. It involves injecting local anaesthetic into the fascial plane anterior to the thoracolumbar fascia. ⋯ We describe a TQL block at the same level in the lateral position using a transverse posterolateral approach to provide analgesia for patients undergoing abdominal surgery. We elaborate on these two approaches of TQL block at the L2 level, in relation to the anatomy, sonoanatomy and technical aspects.