Dan Med Bull
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The present study describes risk factors, the incidence of complications and mortality in the anaesthetized patient. The aims were further to identify additional patient-, anaesthesia-, technique-, and surgery-related factors associated with cardiopulmonary complications and mortality, to describe the value of preoperative radionuclide cardiography in patients with cardiopulmonary insufficiency, and to evaluate the importance of perioperative manual evaluation of the response to train-of-four nerve stimulation for the occurrence of residual neuromuscular blockade in the recovery room. Complications attributable to anaesthesia-complications caused mainly by the anaesthetic procedure-occurred in 0.6% (1:170) of the patients, and mortality attributable to anaesthesia was found to be 0.04% (1:2500). ⋯ Postoperative pulmonary complications in comparable groups of patients depend primarily on the type of surgery, as major abdominal surgery was related to the highest incidence of pulmonary complications. Regional anaesthesia may be a superior technique to general anaesthesia, especially in elderly patients with chronic obstructive lung disease admitted to major orthopaedic surgery. Furthermore, in avoidance of postoperative complications such as residual neuromuscular blockade, the choice of muscle relaxant was more decisive than was manual evaluation of the response to train-to-four nerve stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)
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Comparative Study
Short- and long-term survival after aortic balloon valvuloplasty for calcified aortic stenosis in 137 elderly patients.
Percutaneous transluminal balloon aortic valvuloplasty was performed in 137 patients with symptomatic severe calcified aortic stenosis (50 men and 87 women, mean age 77 years) between December 1986 and September 1990. The purpose of the study was to evaluate short- and long-term survival after balloon aortic valvuloplasty, mean follow-up was 19 months. At the time of balloon aortic valvuloplasty congestive heart failure (NYHA III-IV) was present in 89%, angina pectoris in 47%, and syncope in 31% of the patients. Aortic balloon dilatation produced significant decreases in peak pressure gradient from 91 +/- 34 mmHg to 40 +/- 26 mmHg (p < 0.001). The procedure related mortality was 8% (11 pts) and the 30-days mortality 17% (23 pts). Severe complications occurred in 25% of the patients during the procedure and within the first 24 hours. Immediate clinical improvement was noted in 68% of the patients surviving the treatment. The overall survival rate was at one, two, three and four years follow-up 63%, 40%, 28%, and 21%, respectively. These survival rates were all statistically different from the survival rates in an age- and sex-matched background population (p < 0.001). A multivariate Cox analysis revealed that only female sex and angina before treatment seemed to improve survival. ⋯ The long-term outcome after aortic balloon valvuloplasty for severe aortic stenosis is so poor that we recommend aortic valve replacement as the initial treatment in these patients, if at all possible.