Anaesthesia
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Comparative Study
Monitoring of haemostasis in liver transplantation: comparison of laboratory based and point of care tests.
During orthotopic liver transplanatation haemostasis is often disturbed and coagulation monitoring is mandatory. We compared the results obtained by whole blood prothrombin time and activated partial thromboplastin time assays (Hemochron) and thrombelastometry (ROTEM) 05) with laboratory coagulation assays (prothrombin time, activated partial prothrombin time, fibrinogen, and platelet count) in samples obtained during orthotopic liver transplantations. ⋯ Maximum clot firmness as determined by thrombelastometry correlated well with platelet count (r = 0.779, p < 0.001) and, to a lesser degree, with fibrinogen concentration (r = 0.590, p < 0.001). During orthotopic liver transplantation, prothrombin time and activated partial prothrombin time can be reliably determined by the Hemochron device, while thrombelastometry allows assessment of platelet count and fibrinogen concentration.
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Reduced HLA-DR expression on monocytes has been suggested as a predictive marker of immunosuppression following very high risk surgery, but there are few reports in lower risk surgery. In 32 patients undergoing low to intermediate risk surgery, blood samples were analysed by flow cytometry for HLA-DR expression and numbers in both CD14(high) and CD14(low)CD16+ monocyte subsets. ⋯ This reduction of monocyte HLA-DR expression 24 h following lower risk surgery raises questions about the purported clinical utility of this biomarker as an early predictor of postoperative complications. Our results also suggest that surgery induces significant trafficking (i.e. mobilisation, margination and extravasation) of monocyte subsets, and that monocyte HLA-DR depression is the result of a down-regulatory phenomenon (decreased protein expression on each cell) rather than the differential trafficking of monocyte subsets.
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The aim of this study was to validate a novel inexpensive training device as a means of improving the psychomotor skills involved in the manipulation of a fibreoptic endoscope. Seventy-five subjects attempted to pass a fibreoptic endoscope through the device five times, with each attempt timed to the nearest second. ⋯ Qualitative feedback indicated that the device required subjects to use similar skills to those used in clinical practice. This study supports the use of such a device in training and assessment although further studies will be required to determine whether the skills learned on the device can be transferred to the clinical environment.
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Case Reports
Unrecognised dural puncture resulting in subdural hygroma and cortical vein thrombosis.
Unrecognised dural punctures are difficult to diagnose early. Failure of recognition may lead to sinister consequences. A case of unrecognised dural puncture in a young female leading to the development of subdural hygroma and cortical vein thrombosis is presented. The dilemma in the diagnosis of headache in such patients along with the significance of follow-up of all, including attempted, epidurals is also discussed.
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This prospective study determined the level of radiation exposure of anaesthetists during interventional radiological procedures performed in the endoscopic retrograde cholangiopancreatography suite and cardiac catheterisation laboratory and compared it with the current safety guidelines. Anaesthetists wore area-specific lithium fluoride thermo-luminescent dosimeter badges at standardised positions. A total of 1344 procedures were performed over a 6-month period. ⋯ The mean (SD) fluoroscopy time per procedure for endoscopic retrograde cholangiopancreatography was 5.5 (4.1) min compared with 12 (10.9) min in the cardiac catheterisation suite (p < 0.001). The combined net radiation exposure over 6 months was 0.28 mSv for endoscopic retrograde cholangiopancreatography procedures and 2.32 mSv in the cardiac catheterisation suite. The combined exposure was less than the maximum recommended exposure of 20 mSv per year.