The Journal of international medical research
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This retrospective study investigated preoperative markers of appendix perforation in 351 acute appendicitis cases: group 1, appendicitis not histologically confirmed; group 2, appendicitis without perforation or gangrenous changes; and group 3, histologically confirmed perforated appendicitis with gangrenous changes. In group 3, symptom duration was significantly longer, and white blood cell (WBC) and bilirubin values significantly higher, than for the other groups. Symptom duration, gender, bilirubin and elevated WBC were significantly associated with early diagnosis of acute appendicitis in univariate analysis. ⋯ Receiver operating characteristic curve analysis showed good discrimination of bilirubin and moderate discrimination of WBC as markers of appendix perforation. It is concluded that assessment of preoperative total bilirubin is useful for the differential diagnosis of perforated versus acute suppurative appendicitis, whereas WBC assessment is effective for diagnosing the presence versus absence of appendicitis. Symptom duration, WBC and total bilirubin should be used as independent parameters in the early diagnosis of appendix perforation.
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This observational study investigated which of the three most common definitions of intraoperative hypotension (IOH), reported in a published systematic literature review, were associated best with anaesthetists' administration of antihypo tensive medication (AHM). IOH and AHM use in anaesthetic procedures in a mixed surgical population (n = 2350) were also reviewed. The definitions were: arterial systolic blood pressure (SBP) < 100 mmHg or a fall in SBP of > 30% of the preoperative SBP baseline; arterial SBP < 80 mmHg; a fall in SBP of > 20% of the preoperative SBP. ⋯ The three original definitions correlated poorly with the anaesthetist's judgement about applying AHM. Anaesthetists make complex decisions regarding the relevance of IOH, considering various perioperative factors in addition to SBP. Age, physical status and duration and type of surgery showed better correlations with postoperative in-patient stay than IOH.
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Comparative Study
Preoperative insertion of an intra-aortic balloon pump improved the prognosis of high-risk patients undergoing off-pump coronary artery bypass grafting.
This study investigated the efficacy and safety of preoperative insertion of an intra-aortic balloon pump (IABP) in high-risk coronary atherosclerotic disease patients undergoing off-pump coronary artery bypass grafting (OPCAB). A total of 232 patients were recruited to the study, of whom 107 underwent percutaneous insertion of an IABP prior to OPCAB. The remaining 125 patients underwent OPCAB alone. ⋯ Preoperative insertion of an IABP was associated with a shorter stay in intensive care, decreased incidence of postoperative dialysis and acute heart failure, and a reduction in postoperative mortality compared with OPCAB alone. There were no between-group differences in terms of haematocrit level, number of distal anastomoses, volume of postoperative drainage or incidence of reoperation for bleeding and postoperative stroke/cerebrovascular accident. In conclusion, preoperative insertion of an IABP improved the prognosis of high-risk CAD patients undergoing OPCAB.
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Comparative Study Clinical Trial
Effect-site concentration of remifentanil for nasotracheal versus orotracheal intubation during target-controlled infusion of propofol.
The concentration of remifentanil required for acceptable nasotracheal intubation in adults after target-controlled infusion (TCI) of propofol without neuromuscular blockade was compared with that required for orotracheal intubation. Twenty-five patients undergoing oral and maxillofacial surgery received nasotracheal intubation and 25 undergoing ear, nose and throat surgery received orotracheal intubation. Anaesthesia was induced with propofol TCI at a target effect-site concentration of 5.0 μg/ml. ⋯ The EC(50) (± SD) values for remifentanil, calculated using a modified Dixon's up-and-down method, were 6.08 ± 0.75 and 5.58 ± 0.75 ng/ml for nasotracheal and orotracheal intubation, respectively. Effect-site remifentanil concentrations did not differ significantly between the two groups of patients. Coadministration of propofol and remifentanil can provide acceptable conditions for nasotracheal intubation without neuromuscular blockade.
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This retrospective study used abdominal computed tomography (CT) scan images to determine the optimal safe oblique angle for fluoroscopy in fluoroscope-assisted coeliac plexus block (CPB). Abdominal CT scans from 131 patients were included in the study: 42 patients with cancer of the pancreas head, 45 with cancer of the pancreas body and tail and 44 with chronic pancreatitis. ⋯ There was no difference in the oblique angle between the patient groups. The optimal oblique angle for fluoroscopy was determined to be 17° for right T12, 18° for left T12, and 19° for both left and right L1.