Anaesthesia
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Hip fracture surgery is associated with a high rate of mortality and morbidity; heart disease is the leading cause and is often unrecognised and inadequately treated. Pre-operative focused transthoracic echocardiography by anaesthetists frequently influences management, but mortality outcome studies have not been performed to date. Mortality over the 12 months after hip fracture surgery, in 64 patients at risk of cardiac disease who received pre-operative echocardiography, was compared with 66 randomised historical controls who did not receive echocardiography. ⋯ Hazard of death was also reduced with pre-operative echocardiography over 12 months after adjustment for known risk factors (hazard ratio 0.41, 95% CI 0.2-0.85, p=0.016). Pre-operative echocardiography was not associated with a delay in surgery. These data support a randomised controlled trial to confirm these findings.
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We prospectively evaluated the CEL-100 videolaryngoscope(TM) for insertion of double-lumen tracheal tubes in 48 consecutive patients who had been found to have an unanticipated Cormack and Lehane grade 3 (n=43) and grade 4 (n=5) laryngeal view and in whom two attempts at tracheal intubation using the Macintosh laryngoscope had failed. When the CEL-100 was subsequently employed, the glottic view improved in 45 (94%) patients. ⋯ This occurred on the first attempt in 27 (56%) patients, 14 (29%) on the second and two (4%) on the third. We conclude that the CEL-100 videolaryngoscope is an effective device in this context, and we therefore propose that this device can be used in circumstances when double-lumen tube insertion proves difficult.
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We investigated whether genetic variations of the beta-2 adrenergic receptor (ADRB2) modulate the haemodynamic response following spinal anaesthesia for caesarean delivery. We focused on the effects of haplotypes formed by combinations of the Arg16Gly and Gln27Glu polymorphisms. Clinical data from 143 healthy parturients were collected. ⋯ Both groups presented similar baseline characteristics. Comparatively, patients homozygous for the ArgGln haplotype presented consistently higher blood pressure levels throughout the evaluation period (p=0.001 for systolic arterial pressure variation from baseline). In conclusion, our results demonstrate that haplotype variations of the the ADRB2 modulate the haemodynamic response following spinal anaesthesia for caesarean delivery.
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Standard cardiorespiratory monitoring may fail to detect occult tissue ischaemia. This study assessed whether a near infra-red spectroscopy tissue oxygen saturation monitor (InSpectra™) could detect progressive peripheral tissue ischaemia and whether hyperoxia may confound tissue oxygen saturation measurement. ⋯ The rate and magnitude of decreases in tissue oxygen saturations were greater during high- than low-pressure ischaemia with a mean (SD) desaturation rate of 3.3 (0.9) vs 1.8 (0.8) %.min(-1) (p<0.01). The dose-related association and lack of confounding by hyperoxia suggest that tissue oxygen saturation monitoring may be a useful adjunct to detect occult ischaemia.