British Journal of Anaesthesia - current issue

British Journal of Anaesthesia - RSS feed of current issue
  1. Rapid Review Anesthesiology Oral Boards
  2. Regional Anaesthesia: A Pocket Guide
  3. Problem-Based Transesophageal Echocardiography
  4. The (Correct) use of capnography will reduce airway complications in intensive care
  5. Doses and effects of levobupivacaine and bupivacaine for spinal anaesthesia
  6. Atlas of Ultrasound-Guided Regional Anaesthesia
  7. Making bisoprolol a perioperative agent
  8. Dynamic parameters in the operating theatre: brightness goes with shadows
  9. Benefits of continuous capnography monitoring for intensive care patients significantly outweigh any risks
  10. Does adding milk to tea delay gastric emptying?
  11. Cut tracheal tube and GlideRite(R) Rigid Stylet
  12. (Bright) future of dynamic parameters is in the operating theatre
  13. Abstracts of the Chinese Society of Anesthesiology: Tianjin, China, September 2013
  14. High-frequency jet ventilation shortened the duration of gas embolization during laparoscopic liver resection in a porcine model
    Background

    Positive pressure mechanical ventilation causes rhythmic changes in thoracic pressure and central blood flow. If entrainment occurs, it could be easier for carbon dioxide to enter through a wounded vein during laparoscopic liver lobe resection (LLR). High-frequency jet ventilation (HFJV) is a ventilating method that does not cause pronounced pressure or blood flow changes. This study aimed to investigate whether HFJV could influence the frequency, severity, or duration of gas embolism (GE) during LLR.

    Methods

    Twenty-four anaesthetized piglets underwent lobe resection and were randomly assigned to either normal frequency ventilation (NFV) or HFJV (n=12 per group). During resection, a standardized injury to the left hepatic vein was created to increase the risk of GE. Haemodynamic and respiratory variables were monitored. Online blood gas monitoring and transoesophageal echocardiography were used. GE occurrence and severity were graded as 0 (none), 1 (minor), or 2 (major), depending on the echocardiography results.

    Results

    GE duration was shorter in the HFJV group (P=0.008). However, no differences were found between the two groups in the frequency or severity of embolism. Incidence of Grade 2 embolism was less than that found in previous studies and physiological responses to embolism were variable.

    Conclusion

    HFJV shortened the mean duration of GE during LLR and was a feasible ventilation method during the procedure. Individual physiological responses to GE were unpredictable.

  15. Relationship between early postoperative C-reactive protein elevation and long-term postoperative major adverse cardiovascular and cerebral events in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study
    Background

    Inflammation plays a key role in the pathogenesis of vascular occlusive diseases, such as myocardial infarction and stroke. Additionally, these conditions are predicted by C-reactive protein (CRP), a general inflammation marker. We hypothesized that the inflammation induced by surgery itself augments vascular occlusive disease. We retrospectively evaluated the relationship between postoperative CRP elevation and postoperative major adverse cardiovascular and cerebral events (MACCE) in patients undergoing off-pump coronary artery bypass surgery (OPCAB).

    Methods

    The electronic medical records of 1046 patients who underwent OPCAB were reviewed retrospectively. The relationship between postoperative serum CRP and long-term postoperative MACCE (median follow-up 28 months) was investigated.

    Results

    Patients were divided into quartiles according to maximum postoperative CRP levels (<18, 18–22, 22–27, ≥27 mg dl–1). The adjusted hazard ratios (HRs) were 2.15, 2.45, and 2.81, respectively (P=0.004), compared with the lowest quartile (<18 mg dl–1). In the multivariate analysis, the postoperative CRP quartile (HR 2.81; P=0.004), postoperative non-use of statins (HR 1.86; P=0.003), and postoperative maximum troponin I (HR 1.02; P<0.001) independently predicted postoperative MACCE, while preoperative CRP did not (P=0.203). Several parameters were correlated with postoperative maximum CRP level: body temperature (P=0.001) and heart rate (P<0.001) at the end of surgery; intraoperative last lactate (P<0.001) and base excess (P<0.001); and red blood cell transfusion (P=0.019).

    Conclusions

    Postoperative CRP elevation was associated with long-term postoperative MACCE in OPCAB patients. This was mitigated by postoperative statin medication. Furthermore, postoperative CRP elevation was associated with intraoperative parameters reflecting hypoperfusion and inflammation.