Background: Adverse events (AEs) are patient injuries caused by medical care. Previous studies have reported increased mortality rates and prolonged hospital length of stay in patients having an AE. However, these studies have not adequately accounted for potential biases which might influence these associations. We performed this study to measure the independent influence of intensive care unit (ICU) based AEs on in-hospital mortality and hospital length of stay.
Tourniquet inflation during arthroscopic knee ligament surgery does not increase postoperative painPurpose: A double-blind clinical trial was conducted to determine the effect of inflation of a thigh tourniquet during anterior cruciate ligament repair on arthroscopic visibility, duration of procedure, postoperative pain and opioid consumption. Methods: Thirty patients were randomly allocated into two groups; Group I had the thigh tourniquet inflated during surgery whereas the tourniquet was not inflated in Group II patients. All patients received standardized general anesthesia and postoperative pain management. Supplemental analgesia was provided with iv morphine via a patient-controlled analgesia (PCA) apparatus. Verbal pain rating scores (0-10) were obtained after surgery. Results: Arthroscopic visibility was impaired in Group II patients (P < 0.0001), but this was ameliorated by increased irrigation flow or addition of epinephrine. Duration of surgery was similar in both groups. There was no difference between groups in postoperative morphine consumption (9.8 +-7. I mg in Group I vs I 1.4 +_ 10.2 mg in Group II) or in postoperative pain scores between groups. Conclusion: Inflation of a thigh tourniquet did not result in increased pain or opioid consumption after arthroscopic ACL surgery. Arthroscopic visibility was somewhat impaired in some patients without the use of tourniquet. Finally, the duration of the surgical procedure was not increased in patients where the tourniquet was not inflated during the ACL repair.Objectif: Un essai clinique en double aveugle a 6t6 men6 pour d&erminer I'effet du gonflement d'un garrot la cuisse, pendant la r6paration du ligament crois6 ant&ieur (LCA), sur la visibilit~ arthroscopique, la dur6e de I'intervention, la douleur postop&atoire et la prise d'opio'ides. M&hode : Trente patients ont 6t6 r6partis au hasard en deux groupes : on a gonfl6 le garrot ~ la cuisse clans le groupe I, mais non dans le groupe II. Tous ont re~u une anesth4sie g~n&ale standard et un traitement pour la douleur postop&atoire. Panalg&ie suppl4mentaire a 6t~ administr6e avec de la morphine iv au moyen d'un dispositif d'analg&ie contr61& par le patient (ACP). Les scores verbaux de douleur (0-10) ont 6t6 obtenus apr6s I'op&ation. l~a~altats : La visibilit6 arthroscopique a ~t6 alt&6e chez les patients du groupe II (P < 0,0001), mais la situation a 6t6 corrig6e par I'augmentation du d6bit d'irrigation ou I'ajout d'6pin6phrine. La dur& de rop&ation a 6t6 similaire dans les deux groupes. II n'y a pas eu de diff&ence intergroupe quant ~ la consommation de morphine postop&atoire (9,8 _+ 7, I mg dans le groupe I vs I 1,4 + 10,2 mg dans le groupe II) ou aux scores de douleur postop&atoire. Conclusion : Le gonflement d'un garrot ~ la cuisse n'a pas provoqu6 d'augmentation de la douleur postop&a-toire ou de prise d'opio'ides. La visibilit6 arthroscopique a &6 un peu alt&& dans le cas de certains patients chez qui le garrot n'&ait pas gonfl& La dur~e de I'intervention n'a cependant pas &6 augment6e pour les pati...
Summary In this state‐of‐the‐art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre‐operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri‐operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID‐19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri‐operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post‐procedural evaluation.
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