Anaesthesia
-
While evidence from preclinical and observational cohort studies have suggested potential disparities in tumour behaviour associated with the choice of intra-operative anaesthetics, clinical evidence of tumour recurrence and metastasis remains inconclusive. We aimed to compare the impact of intra-operative anaesthesia on oncologic outcomes following hepatectomy for hepatocellular carcinoma. ⋯ Intra-operative anaesthesia technique did not affect postoperative recurrence and overall survival in patients with hepatocellular carcinoma undergoing hepatectomy.
-
The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%-< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care. ⋯ These data describe constraints in access to postoperative and emergency enhanced/critical care in the south-west of England. There is poor compliance with national guidance regarding the postoperative care location of patients with a moderate or high risk of postoperative mortality.
-
Approximately 1% of the UK population is prescribed oral corticosteroids at any one time. It is not known how many of these patients present for major surgery. We aimed to establish the prevalence, characteristics and outcomes of patients taking oral corticosteroids. ⋯ Around 1 in 29 patients undergoing major surgery are taking oral corticosteroids for > 28 days in the 3 months before major surgery. Their outcomes are poor and warrant highlighting within care pathways to aid risk prediction and mitigation.
-
The diagnostic accuracy of gastric ultrasound in children has not been assessed thoroughly. We aimed to determine the sensitivity and specificity in children of a qualitative ultrasound examination of the gastric antrum in the supine 45° semi-recumbent position and a clinical algorithm for detecting a gastric fluid volume > 1.25 ml.kg-1, reported to represent an 'at-risk stomach' for pulmonary aspiration. ⋯ In order to achieve high sensitivity of gastric ultrasound for the diagnosis of fluid volume > 1.25 ml.kg-1 in children, qualitative ultrasound assessment of gastric antrum contents should be combined with calculation of gastric fluid volume when fluid contents are seen in the gastric antrum.