The study investigated the routine introduction of a new surgical consent form containing a tissue consent section to investigate patient attitudes to the use of surplus tissue for research (after the Alder Hey inquiry) and also the differing approaches by consent takers. All surgical consent forms received in histopathology for the same 2-month period in 2 consecutive years were analysed, recording available information about the specimen, the tissue consent section and, for the second year, the consent taker. The findings showed that <5% of patients whose views were recorded disagreed with the use of their tissue for research. They also showed that the number of completed forms sent to histopathology had increased but the pattern of completion had changed very little. A wide variation between departments and also between clinicians was apparent in the levels of completion of the tissue consent section, suggesting wide variability in the quality of the consenting process. When asked, patients rarely object (<5%) but if the highest standards of consent for surgical tissue are to be achieved and the wishes of patients to donate tissue are to be effectively recorded then new resources or approaches will be needed for this process.
SummaryThe successful management of a patient with Eisenmenger 's syndrome undergoing bilateral herniorrhaphy is described, and some of the anaesthetic problems associated with this condition are considered. The case is reported because epidural anaesthesia is performed rarely in these patients. The use of subcutaneous heparin, the level of monitoring required, and the value of pulse oximetry are also discussed. Key wordsAnaesthetic techniques, regional; epidural. Complications; Eisenmenger's syndrome.In 1958 Wood' defined Eisenmenger's syndrome as 'pulmonary hypertension at or close to systemic level with reversed or bidirectional shunting at aortopulmonary, ventricular, or atrial level'. The condition is rare, but patients may survive into their 4th or 5th decadesZ and require anaesthetic management for incidental surgery. Patients have been managed successfully with general anaesthesia and several authors 3-5 have advocated this in preference to epidural blockade for lower abdominal or lower limb surgery. However, the peri-operative mortality rate remains high,4 and especially in labour with a maternal mortality of about 30% during vaginal delivery6-' and up to 75% after Caesarean section. ' Epidural anaesthesia has been employed in only a few cases8-10 because of the possible adverse effects on the systemic vascular resistance and hence the size of the shunt, but there were no significant complications in these patients. We report a further case managed successfully with epidural anaesthesia to highlight the problems associated with this condition and to discuss the level of monitoring required. Case historyA 43-year-old male patient was admitted for elective bilateral inguinal herniorrhaphy. Eisenmenger's syndrome had been confirmed at the age of 16 years by catheter studies which demonstrated a large ventricular septa1 defect (VSD) with equalisation of pressures between the pulmonary and systemic circulations. He was leading an active life at this time and complained of shortness of breath only when he walked up hills. He was reviewed in 1977 as a result of increasing dyspnoea when secondary polycythaemia with a packed cell volume of 0.65 was noted and treated by intermittent venesections. He was admitted with a chest infection and right-sided heart failure from which he made a good recovery in 1983. However, 2 days after discharge he was re-admitted with distended nonpulsatile right-sided neck veins and a swollen and discoloured right arm. Angiography demonstrated right subclavian and brachiocephalic vein thrombosis which was successfully treated with anticoagulant therapy. Warfarin was discontinued 3 months later and subsequently the patient remained well.He became breathless on walking upstairs or about 100 yards on the flat during his present admission. Examination showed he was cyanosed with finger clubbing and the jugular venous pulse was slightly elevated with a prominent 'a' wave, but there were no signs of peripheral oedema.Blood pressure was 160/90 mmHg, pulse rate 84 beats/ minute, in sinus rh...
MATHIAS JA, E V A V S -P R~S S~R CDG. CHURCHILL-DAVIDSOU IIC.The role of the non-depolariring drugs in the prevention of ~uxemethonium hrddycdrdia. Brrrirh Journal q/ 4nnrsrlit4i 1970; 4 2 609-13.
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