Anaesthesia
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Randomized Controlled Trial
A randomised controlled trial of radial artery cannulation guided by Doppler vs palpation vs ultrasound.
We randomly allocated 749 participants to radial artery cannulation by anaesthetic trainees, guided by Doppler (244), palpation (256) or ultrasound (249). Ultrasound increased the rate of cannulation at the first attempt by 14% (95% CI 5-22%), from 39% with Doppler or palpation, p = 0.002 for both. There were no differences in the rates of cannulation 5 min after the procedure started: 147/244 (60%) with Doppler; 160/256 (63%) with palpation; and 171/249 (69%) with ultrasound, p = 0.13.
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Thirty-day mortality following emergency laparotomy is high, and greater amongst elderly patients. Studies systematically describing peri-operative complications are sparse, and heterogeneous. We used the postoperative morbidity survey to describe the type and frequency of complications, and their relationship with outcomes for 144 patients: 114 < 80 years old, and 30 ≥ 80 years old. ⋯ Regression analysis indicated that cardiovascular, haematological, renal and wound complications were associated with longer hospital stay, and that cardiovascular complications predicted mortality. The postoperative morbidity survey system enabled structured mapping of the number and type of complications, and their relationship with outcome, following emergency laparotomy. These results indicate that rather than a greater propensity to complications following surgery, it was the failure to tolerate these that increased mortality in the elderly.