Anaesthesia
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Atrial fibrillation is the most frequent arrhythmia after thoracic surgery and is associated with increased hospital costs, morbidity and mortality. In this study, we aimed to identify potentially modifiable risk factors for postoperative atrial fibrillation following lung resection surgery and to suggest possible measures to reduce risk. We retrospectively reviewed the medical records of 4731 patients who underwent lobectomy or more major lung resection over a 6-year period. ⋯ We conclude that high alcohol consumption, red cell transfusion, use of inotropes and open surgery are potentially modifiable risk factors for postoperative atrial fibrillation. Pre-operative alcohol consumption needs to be addressed. Avoiding red cell transfusion and performing lung resection via video-assisted thoracoscopic surgery may reduce the incidence of postoperative atrial fibrillation and the administration of vasopressors rather than inotropes is preferred.
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The objective was to develop a sodium percarbonate/water/catalyst chemical oxygen generator that did not require compressed gas. Existing devices utilising this reaction have a very short duration of action. ⋯ Having undertaken full-scale experiments using a stainless steel vessel, an optimum combination of reagents was found to be 1 litre water, 0.75 g manganese dioxide catalyst, 60 g sodium percarbonate granules and 800 g of custom pressed 7.21 (0.28) g sodium percarbonate tablets. This combination of granules and slower dissolution tablets produced a rapid initial oxygen flow to 'purge' an attached low-flow breathing system allowing immediate use, followed by a constant flow meeting metabolic requirements for a minimum of 1 h duration.
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Editorial Comment
Pre-operative testing guidelines: a NICE try but not enough.