Anaesthesia
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Factors influencing the family consent rate for organ donation in the UK
Anaesthesia - Tập 71 Số 9 - Trang 1053-1063 - 2016
Diagnostic criteria for pre-operative anaemia-time to end sex discrimination
Anaesthesia - Tập 72 Số 7 - Trang 811-814 - 2017
Postoperative outcomes following cardiac surgery in non‐anaemic iron‐replete and iron‐deficient patients – an exploratory study Summary Iron deficiency anaemia is strongly associated with poor outcomes after cardiac surgery. However, pre‐operative non‐anaemic iron deficiency (a probable anaemia precursor) has not been comprehensively examined in patients undergoing cardiac surgery, despite biological plausibility and evidence from other patient populations of negative effect on outcome. This exploratory retrospective cohort study aimed to compare an iron‐deficient group of patients undergoing cardiac surgery with an iron‐replete group. Consecutive non‐anaemic patients undergoing elective coronary artery bypass grafting or single valve replacement in our institution between January 2013 and December 2015 were considered for inclusion. Data from a total of 277 patients were analysed, and were categorised by iron status and blood haemoglobin concentration into iron‐deficient (n = 109) and iron‐replete (n = 168) groups. Compared with the iron‐replete group, patients in the iron‐deficient group were more likely to be female (43% vs. 12%, iron‐replete, respectively); older, mean (SD) age 64.4 (9.7) vs. 63.2 (10.3) years; and to have a higher pre‐operative EuroSCORE (median IQR [range]) 3 (2–5 [0–10]) vs. 3 (2–4 [0–9]), with a lower preoperative haemoglobin of 141.6 (11.6) vs. 148.3 (11.7) g.l−1 . Univariate analysis suggested that iron‐deficient patients had a longer hospital length of stay (7 (6–9 [2–40]) vs. 7 (5–8 [4–23]) days; p = 0.013) and fewer days alive and out of hospital at postoperative day 90 (83 (80–84 [0–87]) vs. 83 (81–85 [34–86]), p = 0.009). There was no evidence of an association between iron deficiency and either lower nadir haemoglobin or higher requirement for blood products during inpatient stay. After adjusting the model for pre‐operative age, sex, renal function, EuroSCORE and haemoglobin, the mean increase in hospital length of stay in the iron‐deficient group relative to the iron‐replete group was 0.86 days (bootstrapped 95%CI −0.37 to 2.22, p = 0.098). This exploratory study suggests there is weak evidence of an association between non‐anaemic iron deficiency and outcome after cardiac surgery after controlling for potentially confounding variables.
Anaesthesia - Tập 73 Số 4 - Trang 450-458 - 2018
Anaemia in cardiac surgery – a retrospective review of a centre's experience with a pre‐operative intravenous iron clinic Summary Pre‐operative anaemia is associated with higher rates of transfusion and worse outcomes, including prolonged hospital stay, morbidity and mortality. Iron deficiency is associated with significantly lower haemoglobin levels throughout the peri‐operative period and more frequent blood transfusion. Correction of iron stores before surgery forms part of the first pillar of patient blood management. We established a pre‐operative anaemia clinic to aid identification and treatment of patients with iron deficiency anaemia scheduled for elective cardiac surgery. We present a retrospective observational review of our experience from January 2017 to December 2019. One‐hundred and ninety patients received treatment with intravenous iron, a median of 21 days before cardiac surgery. Of these, 179 had a formal laboratory haemoglobin level measured before surgery, demonstrating a median rise in haemoglobin of 8.0 g.l‐1 . Patients treated with i.v. iron demonstrated a significantly higher incidence of transfusion (60%) compared with the non‐anaemic cohort (22%) during the same time period, p < 0.001. Significantly higher rates of new requirement for renal replacement therapy (6.7% vs. 0.6%, p < 0.001) and of stroke (3.7% vs. 1.2%, p = 0.010) were also seen in this group compared with those without anaemia, although there was no significant difference in in‐hospital mortality (1.6% vs. 0.8%, p = 0.230). In patients where the presenting haemoglobin was less than 130 g.l‐1 , but there was no intervention or treatment, there was no difference in rates of transfusion or of complications compared with the anaemic group treated with iron. In patients with proven iron deficiency anaemia, supplementation with intravenous iron showed only a modest effect on haemoglobin and this group still had a significantly higher transfusion requirement than the non‐anaemic cohort. Supplementation with intravenous iron did not improve outcomes compared with patients with anaemia who did not receive intravenous iron and did not reduce peri‐operative risk to non‐anaemic levels. Questions remain regarding identification of patients who will receive most benefit, the use of concomitant treatment with other agents, and the optimum time frames for treatment in order to produce benefit in the real‐world setting.
Anaesthesia - Tập 76 Số 5 - Trang 629-638 - 2021
Borderline anaemia and postoperative outcome in women undergoing major abdominal surgery: a retrospective cohort study Summary Pre‐operative anaemia is typically diagnosed with a haemoglobin concentration < 120 g.l−1 for women and < 130 g.l−1 for men on the basis of limited evidence. This retrospective cohort study stratified women undergoing elective, major abdominal surgery based on pre‐operative haemoglobin concentration: anaemic (< 120 g.l−1 ); borderline anaemic (120–129 g.l−1 ); and non‐anaemic (> 130 g.l−1 ). Data from 1554 women were analysed. Women with borderline anaemia had a greater incidence of postoperative complications (55 (16%) vs. 110 (11%); p = 0.026), longer duration of hospital stay (median (IQR [range]) 3 (1–6 [0–69]) days vs. 2 (1–5 [0–80]) days; p = 0.017) and fewer days alive and out of hospital at postoperative day 30 (median (IQR [range]) 27 (23–29 [0–30]) vs. 28 (25–29 [0–30]) days; p = 0.017) compared with non‐anaemic women. However, after matched cohort analysis, these outcome differences no longer remained statistically significant. After multivariable adjustment for procedure, Charlson comorbidity index and patient age, a negative relationship between logarithmic pre‐operative haemoglobin concentration and duration of stay was found (parameter estimate (standard error) −0.006 (0.003) vs. 0.003 (0.003) for a haemoglobin concentration < 130 g.l−1 vs. > 130 g.l−1 , respectively; p = 0.03); the difference in duration of stay was approximately 50% greater for women with a haemoglobin concentration of 120 g.l−1 compared with those with a haemoglobin concentration of 130 g.l−1 . Although the contribution of borderline anaemia to the incidence of postoperative complications is uncertain, the current diagnostic criteria should be re‐assessed.
Anaesthesia - Tập 75 Số 2 - Trang 210-217 - 2020
The association between borderline pre‐operative anaemia in women and outcomes after cardiac surgery: a cohort study Summary Anaemia is common before cardiac surgery and is associated with increased morbidity and mortality. The World Health Organization (WHO) definition of anaemia is lower for women than for men by 10 g.l−1 , potentially putting women at a disadvantage compared with men with regard to pre‐operative optimisation. Our hypothesis was that women with borderline anaemia (defined by us as haemoglobin concentration 120–129 g.l−1 ) would have a higher rate of red cell transfusion, morbidity and mortality than non‐anaemic women (haemoglobin ≥ 130 g.l−1 ). This retrospective observational study included all adult patients admitted for elective cardiac surgery from January 2013 to April 2016. During the study period, 1388 women underwent cardiac surgery. Pre‐operatively, 333 (24%) had a haemoglobin level < 120 g.l−1 ; 408 (29%) 120–129 g.l−1 ; and 647 (47%) ≥ 130 g.l−1 . Compared with non‐anaemic women, women with borderline anaemia were more likely to be transfused (68.6% vs. 44.5%; RR 1.5, 95%CI 1.4–1.7; p < 0.0001) and were transfused with more units of red cells, mean (SD ) 1.8 (2.8) vs. 1.3 (3.0); p < 0.0001. Hospital length of stay was significantly longer in the borderline anaemia group compared with non‐anaemic women, median (IQR [range]) 8 (6–12 [3–45]) vs. 7 (6–11 [4–60]); p = 0.0159. Short‐ and long‐term postoperative survival was comparable in both groups. Borderline anaemia is associated with increased red cell transfusion and prolonged hospital stay. Future research should address whether correction of borderline anaemia results in improved outcomes.
Anaesthesia - Tập 73 Số 5 - Trang 572-578 - 2018
Air in the epidural space leading to a neurological deficit
Anaesthesia - Tập 58 Số 3 - Trang 292-293 - 2003
Spinal anaesthesia for Caesarean section Summary The effect upon the neonate of a short period of maternal hypotension sustained during the initiation of spinal analgesia for Caesarean section was studied. Babies born to mothers with hypotension were significantly more acidotic than controls although acid‐base levels were still within normal limits. Neuro‐behavioural studies were found to be normal in both groups at 4 and 24 hours. It was concluded that a short period (<2 minutes) of hypotension was not harmful to the neonate.
Anaesthesia - Tập 37 Số 6 - Trang 658-662 - 1982
The use of nitrous oxide in anaesthetic practice: a questionnaire survey Summary Where practicable, exposure to a hazardous substance should be eliminated or adequately controlled. A postal questionnaire survey was sent to 10% of consultants from the Association of Anaesthetists of Great Britain and Ireland, to identify the level of use of nitrous oxide in current anaesthetic practice and identify any change of practice over the last 5 years. Details of anaesthetic practice were requested in three areas: nitrous oxide usage, availability of medical air on anaesthetic machines and the use of total intravenous anaesthesia. Replies were received from 320 consultants (75%). Of these, 49% felt that, over the last 5 years, their use of nitrous oxide had decreased. Twenty per cent of anaesthetists felt that there should be some restriction in availability of nitrous oxide. Where medical air was available, 32% felt that they would use it frequently. A total of 263 (83%) stated that they use total intravenous anaesthesia to some extent. The results showed that, although 49% of consultant anaesthetists had reduced their use of nitrous oxide, this was due to medical considerations rather than concerns over health and pollution issues arising from the use of nitrous oxide.
Anaesthesia - Tập 57 Số 12 - Trang 1155-1158 - 2002
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