Key Clinical MessagePeripheral nerve injury following the use of arterial tourniquets is a rare but potentially debilitating complication. Further education on the safe and appropriate practice of tourniquets is imperative to reduce the incidence of tourniquet‐related complications.
Introduction
Genetic polymorphisms are important in explaining the wide interpatient variability that exists in the development of acute kidney injury (AKI) post cardiac surgery. We hypothesised that polymorphisms in 4 candidate genes, namely angiotensin-converting enzyme (ACE), apolipoprotein-E (ApoE), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α) are associated with AKI.
Methods
870 patients who underwent cardiac surgery in Singapore were analysed. All patients who fulfilled stage 1 KDIGO criteria and above were considered to have AKI. This was investigated against various demographic, clinical and genetic factors.
Results
Increased age, history of hypertension, anaemia and renal impairment remained important preoperative risk factors for AKI. Intraoperatively, longer cardiopulmonary bypass (CPB) time and the use of intra-aortic balloon pump (IABP) were shown to be associated with AKI. Among the genetic factors, ACE-D allele was associated with an increased risk of AKI while IL6-572C allele was associated with a decreased risk of AKI.
Conclusion
ACE-D allele was associated with the development of AKI similar to other studies. On the other hand, IL6-572C was shown to have a protective role against the development of AKI, contradictory to studies done in the Caucasian population. This contradictory effect of IL6-572C is a result of a complex interplay between the gene and population specific modulating factors. Our findings further underscored the necessity of taking into account population specific differences when developing prediction models for AKI.
Introduction: The development of facial pressure ulcers after prone positioning is a well-known complication and a common source of patient dissatisfaction. Several risk factors have been identified in past studies. However, few studies have focused on the Asian population. We therefore set forth to identify the incidence of facial pressure ulcers following surgery in the prone position in our local population, as well as determine possible risk factors for their development. Methods: We recruited 132 patients who underwent elective surgery in a prone position under general anaesthesia in our tertiary hospital. The occurrence of facial pressure ulcers was analysed against several demographic and intraoperative factors. Statistical significance was taken as p<0.05. Results: A total of 114 patients were included in the final analysis. The overall incidence of facial pressure ulcers was 35%. The most common locations were the cheeks (75%), and the forehead (43%). Increased age (OR 1.04 per year, p=0.035) and a prolonged duration of surgery (OR 2.05 per hour, p<0.001) were both significantly associated with facial pressure ulcers. Conclusion: Facial pressure ulcers are common following surgery in a prone position in our local context. This first study on the Southeast Asian population corroborates with known risk factors for pressure ulcer development. Future studies may explore possible risk reduction measures to reduce the incidence of facial pressure ulcers in Southeast Asian populations.
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